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i r'Tfie free Adobe Reader may be used to view and co e this Form. However,software must be purchased to cornpY f I e,and reuse a saved form. <br /> File Original with DWR State of California DWR Use Only—Do Not Fill In <br /> Page of Well Completion Report <br /> Refer to lnslnrctionPamphlet State Well NumberlSite Number <br /> Owner's Well Number MW-3 No. e072350 IN w <br /> Date Work Began 04/18/2008 Date Work Ended 4/18/2008 Latitude Longitude <br /> Local Permit Agency San Joaquin County Environmental H?,alth Department <br /> Permit Number 53845 Permit Date 418108 1 APNITRSICther <br /> Geologic Log Well Owner <br /> 1 Orientation OVertical 0Horizontal OAngle Specify Name BPIARCO <br /> Drilling Method Drilling Fluid <br /> Depth from Surface Description _ Mailing Address 4 Centerpointe Drive <br /> Feet .to Feet Describe material, •rain size,color,etc Cit La Patma State_CA <br /> WeII.Location.. <br /> Address 1612 West Hammer Lane <br /> City Stockton County San Joaquin <br /> Latitude N Longitude w <br /> Dec. in Sec. Deo. Min. Sea <br /> Datum Decimal Lat. Decimal Long. <br /> APN Book70 7 Page 28 Parcel 002 <br /> Townshi L_.1 Ran a Section <br /> IiLoeation Sketch. Activity <br /> Sketch must be drawn by hand after form isprinted.) 0 New Well <br /> North O Modification/Repair <br /> O Deepen <br /> ;f O Other <br /> ° LJ <br /> U 0 Destroy <br /> 1. Describe procedures and materials <br /> under'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> N ; <br /> M ❑Irrigation [:]Industrial <br /> Lu <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> f ` O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> ?} iY South <br /> O Test Well <br /> Illustrate m describe dwanca of well from roads,bulidings,lances, O Vapor Extractionrl,r e[c,end eltach a reap.Use add liana!paper it necessary. O Other <br /> please b!accurate and corn late. <br /> Water L&,b and.Yield of Cam Ieted Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring i65 Feet Estimated Yield' (GPM) Test Type <br /> + Test Length (Hours) Total Drawdown (Feet) <br /> ff Total Depth of Completed Well s Feet 'Ma not be representative of a well's long term yield, <br /> 1# <br /> Cash s Annular Material <br /> Depth from Borehole Type Matenal Wall Outside Screen Slot Size '� Depth from <br /> Surface Diameter Thickness Diameter Type if Any Surface Fill Description <br /> ( Feet to Feet Inches Inches Inches Inches Feet to Feet _ <br /> 6. if I <br /> i <br /> hI <br /> Attachments- _; Certification Statement <br /> ❑ Geologic Log I,the undersigned,certify that this report is complete,'land accurate to the best of my knowledge and belief i <br /> ❑Well Construction Diagram Name Allan Duddin Stratus Environrriental Inc. far Woodward Drilling <br /> Person,Firm or Corporation I,F <br /> ❑ Geophysical Log(s) 3330 Cameron Park Drive #550 Cameron Park CA 95682 <br /> ElSoil[Water Chemical Analyses x xkress .f City State zip <br /> ❑ Other Signed x'11 Z 4/30108 710079 <br /> Attach additional information.if it exists, C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> DWR 188 REV.112ODS 1F ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> , <br />