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*The free Adobe Reader maybe used to view and complete this form However,soft;vare must be purchased to complete,save,and reuse a saved form. <br /> File Original with DWR State of California DWR Use°Oiil =Do;Nof:Flllitta <br /> 1 Well Completion Report f <br /> Page 3 of 6 Refer to rrarruaRon Pamphlet I ,T t StateWellNumber/Site Number 1 <br /> Owner's Well Number MW-3 NO. e(1149226 I I I I INI I I Iw <br /> Date Work Began 03/26/2012 Date Work Ended 3127120,12 Latitude Lon itude <br /> Local Permit Agency San Joaauln County Environmental Health Der <br /> Permit Number NA Permit Date 3122112 APNrTRtS her <br /> G,eolo'is Lo Well Owner <br /> Orientation OVertical O Horizontal OAngle Specify_. Narr a Four B's Partnership 019 Dan Fecher <br /> tomaterial,- r i 9 r C til ng Vineland 71 W. Park Avenue State' — <br /> Drilling Method Hollow Stem Auger Driltin Fluid Bentonito mud <br /> • Depth�fcom Stfrface Descripfion <br /> N_Zi 08360 <br /> 7$t"eet - 0 Fit Pressure Groutbe- a n s ze,colo etc Well'Locatiol7 <br /> Addi ess 2850 Loomis Road <br /> City Stockton County San Joaquin <br /> Latit de N Longitude ____yv <br /> Dep. Min. Sec. Deo. Min. Sec. <br /> bat m Decimal Lat. Decimal Long. <br /> AP Book 179 Page 100 Parcel 03. <br /> Tow ship _Range" Section <br /> t6cation:SketchA0iV1tV <br /> (Sketch musibe drimm b .hand.afterform is: lnted. O New Well <br /> North Modification/Repair <br /> Q Deepen <br /> O Other <br /> 0 Destroy <br /> oesam proceduresatw malmlah <br /> ender'GEOLOGIC LOG' <br /> P1a11"r7ed'iJse;3. <br /> Q Water Supply ' <br /> �� C,- Clc 1�1111�n ❑Domestic ❑Public <br /> uJ ❑irrigation ❑Industrial <br /> O Cathodic Protection <br /> Q Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> iilustrat or describe distance swell from roads.buildings.fences. O Vapor Extraction <br /> rivers, ta.and attach a map-Use additions!paper if necessary" Q Other <br /> Please accurate and complete, i <br /> at lr Level and Yield of Corti feted Welt <br /> Dep h to first water (Feet below surface) <br /> Dep h to Static <br /> Wat r Leve! - (Feet) ,Date Measured <br /> Total Depth of Boring 78 Feet Esti ated Yield* (GPM) Test Type <br /> Total Depth of Completed Well 78 Feet Test Length (Hours) Total Drawdown (Feet) <br /> *Ma not be representative of a well's longterm yield. <br /> Casings Annul'ar Material <br /> Depth from Borehole Type Material Wall Oul:side Scree Slot Size Depth from <br /> Surface Diameter Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches In::hes) (lnchesl Feet to Feet <br /> i <br /> I <br /> Attachments CertificatidnZtatefnent _ d. <br /> ❑ Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> 13 Well Construction Diagram Name All Well Abandonment <br /> person,Firm o'Corporation <br /> ❑ Geophysical Log(s) 9245 Beattv Drive;Suite A a mento CA 95826 <br /> ❑ SoililWater Chemical AnalysesAd Oas Y .city state zip <br /> Site Mag signed "'"- =' •: - �- - 3/30/2012 848359 <br /> El Other <br /> Attach additimal information d it exists. C-57 Licensed Water Well Contrac for Date Signed C-57 License Number <br /> DWR 188 REV.112006 IF ADDITIONAL SPACE IS N�:EDED.USE NE% CONSECUTIVELY NUMBERED FORM <br />