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-rnetreeAooDeHeadermaybeused to view and complete this form. However,software must be purchased to complete,save,and reuse a saved form. <br /> File Original with DWR r.r1 State r.f California .�+ i DWR'lJsa Onl -DoiNot FIIF.fn <br /> Page 5 of 6 : -.-Jell Completion Report / <br /> Refer to fm:�rucion Pamphlet State Well Number/Site Number <br /> Owner's Well Number MW-6 No, e0149228 <br /> Hate Work Began 03/26/2012 Date Work Ended FTN <br /> N I W <br /> s��Q� Latitude ton Elude <br /> Local Permit Agency-San J4aauin County Environmental Health Department I <br /> Permit Number_. Permit Date 3122112 APNrrRSrother <br /> Geolo 'ic Log. Well Owner <br /> Orientation O Velitcal O Horizontal OAngle Specify. Na a our B's Partnership CIO Dan Fecher <br /> Drilling Method Hollow Stem Auger Drilling Fluid Bentonite mud <br /> Depth frolit-Surface Description <br /> Mai ing Address 71 W, Park Avenue <br /> Feet to, .Feet. Describe material,grain size,color,etc Cit Vineland State N. _zi 08360 <br /> 136 0 Overdrill entire well removing all well materials. WO Locafioh --- <br /> Grout <br /> _Grout borehole to surface using neat cement: Address 2850 Loomis Road <br /> City Stockton County San Joaquin, <br /> Latitude N Longitude ,____ry <br /> Dem Min. Sec. Dep. Mid. sec, <br /> Dat m Decimal Lat. Decimal Long, <br /> APN Book 179 Page 100 Parcel 03. <br /> Township -,Range, Section <br /> Location Skatch 1 _. ;ActlVs <br /> Sk etch must be.drawn,b .hand after-form is pented, = O New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> Q Destroy <br /> base procadures and materials <br /> under'GEOLOGIC LOG' <br /> O Water Supply <br /> y C�I�GCk 1 N ❑Domestic ❑Public <br /> M ❑irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> Illuslral ordescribe distance at wen ham roads,bulHinps,lances: O Vapor Attraction <br /> dvers, c.and attach a map.use additional paper a necessary, O Other <br /> Phase accurate and com late. <br /> at r.Level and Yield of Com"l`eted'Well. <br /> Dep h to first water (Feet below surface) <br /> Dep-h to Static <br /> Wat r Level (Feet) Date Measured <br /> Total Depth of Boring 136 Feet Esti aced Yield* (GPM) Test Type <br /> Test Length (Hours) Total Drawdown (Feet) <br /> Total Depth of Completed Well 136 Feet *Ma not be representative of a well's long term yield. <br /> Casings Annular Materlal <br /> Depth from Borehole Wall Ou tslde Screen Slot Size Depth from <br /> Surface Dfameter Type Material Thickness Diameter Type if Any Surface Fill Description i <br /> Feet to Feet Inches Inches In,:hes Inches Feet to Feet <br /> Attachments Certification.Statement.. <br /> ❑ Geologic Log i,the undersigned, ce,tify that this re ort,is complete and accurate to the best of my knowledge and belief <br /> ❑ Well Construction Diagram Name All Well Abandonment <br /> Person,Firm ci Corporation <br /> ❑ Geophysical Log(s) 9245 Beatty Drive Suite A Sacramento CA 95826 <br /> ❑ SoillWater Chemical Analyses Addre s _ city state zip <br /> ❑ Other Site MaD Signed ..y'- :`r" ', - '" 3/30/2012 848359 <br /> Attach additional Irdormation If it exists. '5 Licensed Water~ell Contras or Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEX7 CONSECUTIVELY NUMBERED FORM <br />