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-That"Adobe Reader maybe used to view and complete this h m. However,software must be purchased to complete,save,and reuse a saved forth. <br /> File Original with DWR State of California DWR Use Only—Do Not Fill In <br /> Pa1 of 1 WD11 Completion Report � I t <br /> 9e <br /> Owner's Well Number MW-1 Referlo Instruaan Pampnlel State Well Number/Site Number � <br /> No. e0270099 N •• <br /> Dale Work Began 04/28/2015 Date Wnrk E uled15/ 1/2015 Latitude Longitude <br /> Local Permit Agency San Joaa tin County EnyiMal(IQ 1h L.Health Deca-tment <br /> Permit Number Permit Data APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation Oe Vertical O Horizontal CIANgl-- Specify__ Name Huntbrook Holdings LLC <br /> Drilling Method Hollow Stem Auger I:rill lg Iluid Bentonite rnud Mailing Address 2351 Sunset Blvd#170-717 <br /> Depth from Surface Descr poor Stockton ca 95205 <br /> Feet to Feet Describe material din si:n color,etc Cit State�i <br /> 115 10 Drill sample and install Mcnitx%'/ell Well Location <br /> using hollow stem augers Address 3138 E main street <br /> City Stockton County San Joaquin <br /> Latitude N Longitude <br /> Dau. Min. Sec. Dee. Min. Sec. <br /> Datum Dec.Lat. Dec.Long. <br /> APN Book Page Parcel <br /> Township Range Section <br /> Location Sketch Activity <br /> Sketch must be drawn by nand after form is Punta (D New Well <br /> ._—.. North O Modification/Repair <br /> O Deepen <br /> O Other <br /> O Destroy <br /> oe.o-a.a«ee„as aha mataiei. <br /> aaarosoLocic roc <br /> Planned Uses <br /> C) Water Supply <br /> E]Domestic El Public <br /> w ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> .__.. O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> - Monitoring <br /> — O Remediation <br /> O Sparging <br /> South O Test Well <br /> —_ o.taeeenae matance or vron.am�.aa,Weir,tend.,. O Vapor Extraction <br /> em.,d.e.m.-p u.e.ddaio..i pep—f—....,v O Other <br /> --.. Pl­71,1. <br /> ase�>c nu and complete <br /> -- Water Level and Yield of Completed Weil <br /> ---- Depth to first water (Feet below surface) <br /> .--- Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 115 __ _ Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 115 .__ Feet Test Length (Hours) Total Drawdown_(Feet) <br /> _ eMa not be re resentative of a well's Ion term yield. <br /> Casi'g ., Annular Material <br /> Depth from Borehole T Wall Outside Screen Slot size Depth from <br /> Surface Diameter Type Mater: Thickness Dipmeter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet m Feet <br /> 115 95 8 Screen PVC Sch.40 2 Milled Slots 0.010 115 93 Filter Pack #2112 sand <br /> 95 0 8 Blank PVC Son.40 2 93 91 Bentonite pellets <br /> -- 91 Cement portland 1/II <br /> L <br /> Attachments Certification Statement <br /> ,'he undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑ Geologic Log I <br /> ❑ Well Construction Diagram w m: All Well Abandonment inc <br /> Parson,Firth or Corporation <br /> ❑ Geophysical Log(s) :3 j!)Fitzgerald FA Suite B _ Rancho Cordova CA 95742 <br /> ❑ Soil(Water Chemical Analyses Adaese— City state zip <br /> OOther site map Syn¢ii c l-1 6/5/2015 848359 <br /> rn <br /> Anaadditional information if it evsts. I_� C-57 Licensed we ter wen dbr Date Signed C-57 License Number <br /> IVELY NUMBERED FORM <br /> DNR 188 REV.12" IF 1D3 rIONAL SPACE IS NEEDED,USE NE)CT CONSECUT <br />