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'The free Adobe Reader may be used to view and cwmplet0fovn. However,software must be F irchased to complete,say*reuse a saved form. <br /> File Original with DWR State of California DWR Use Only-Do Not Fill In <br /> Well Completion Report ,_� <br /> Page 10 of 16 Refer towsmcow Pampnb:r State Well Number/Site Number <br /> Owner's Well Number OW-6 No. e0150678 _.L_ _ W <br /> �� _�___ N. _1_1 Longitude <br /> Date Work Began 03/26/2012 Date Work Ended 4/3/2012 ,_ Latitude <br /> Local Permit Agency n Da- - - ' En'`ronrnental uaailH Department <br /> APN/TRS/Other <br /> Permit Number NA Permit Date 3/5/12 <br /> Geoloclic Log Well Owner <br /> Orientation OVertical O Horizontal OAngle Specify Name Pensco Trust Co Cust Etal <br /> Drilling Method Hollow Stem Au er Drilling Fluid Bentonite mud Mailing Address PO Box 144 <br /> Depth from Surface DescriptionCitv Linden State CA 71 95326 <br /> Feet to Feet Describe material, rain size,color,etc <br /> 30 0 Drill,Sam Is and Install Well to 30' usin Well Location <br /> well materials listed below. Address 1601 Turnpike Road <br /> City Stockton County San Joaquin <br /> L:ItitudeN Longitude __ <br /> Deo. Min. Sec. bee. Min. Sec. <br /> C 3tum Decimal Lat. Decimal Long. <br /> A PN Book 165 Page 040 Parcel 13 <br /> Tnwnshi Ran a Section <br /> Location Sketch Activity <br /> Sketch must be drawn by hand atter lonv is noted.)) O New Well <br /> North Q Modification/Repair <br /> O Deepen <br /> O Other <br /> - <br /> 0 Destroy <br /> oesaibe pmnd'Land meerels <br /> unEe'GEOLOGIC LOG' <br /> Planned Uses <br /> Q Water Supply <br /> 1 ❑Domestic ❑Public <br /> \ 1 w ❑Irrigation ❑Industrial <br /> Q Cathodic Protection <br /> Q Dewatering <br /> Q Heat Exchange <br /> Q Injection <br /> Q Monitoring <br /> Q Remediation <br /> Q Sparging <br /> Q Test Well <br /> South <br /> III Slue or deacdb.auaosa of.111..macro bmidme..lenma Q` Vapor Extraction <br /> -rs,em mm acorn a map. u.e.ddaioaal cane.if namssary Q Other <br /> v.....a.ocmae..a nom tea. <br /> later Level and Yield of Completed Well <br /> C epth to first water (Feet below surface) <br /> Cepth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 32 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 30 Feet <br /> Test Length (Hours) Total Drawdown_(Feet) <br /> 'INa not be re resentative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Type Material Wall Outside S,:reen 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 /> 30 128 8 Screen Sparge Point 3/4 Micri.po us 30 26 Filter Pack #2/16 <br /> 28 0 8 Blank PVC Sch.40 3/4 26 24 Bentonite Chips <br /> 24 0 Cement Portland type 1/II <br /> Attachments Certification Statement <br /> ❑ Geologic Log I,the undersigned,certify that thi:,report is complete and accurate to the best of my knowledge and belief <br /> ❑ Well Construction Diagram Name All Well Abandonment, <br /> Person.Firm or Corporation <br /> ❑ Geophysical Log(s) 9245 Beatty Drive Suite A Sacramento CA 95826 <br /> �.. <br /> ❑ Soil/Water Chemical Analyses Add ass _? ,-- -^ „�...--' coy slate zip <br /> O Other Site Map SignedT 4/25/2012 848359 <br /> Attach additional imamaticn if it exists_ (.C licensed water a crnvacmr - Date Signed C-57 License Number <br /> DM 168 REV.112006 IF ADDITIONAL SPACE IS NEEDED.USE IJEXT CONSECUTIVELY NUMBERED FORM <br />