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'The free Adobe Reader may be used to view and completeorm. However,software must be pi,rchased to complete,save0reuse a saved form. <br /> File Original with DWR Slate of California DWR Use Onl -Do Not Fill In <br /> 11 Well Completion Report F -T i T—i 77� <br /> Pa �—1 <br /> ge Dt 1s Re/erto Insauoum Pampnk State Well Number/Sne Number <br /> Owner's Well Number OW-7 No. e0150680T TN] __,_I�_ <br /> Date Work Began 03126/2012 Date Work Ended 4/3/2012 ._ Latiwde Lon itude <br /> Local Permit Agency G u f l alth Department _ t i I <br /> Permit Number NA Permit Date 3/5/12 APN(TRS/Other <br /> Geologic Log Well Owner <br /> Orientation 111 0Horizontal OAngle Specify Nr:me Pensco Trust Co Cust Etal <br /> Drilling Method Hollow Slem Au er Drilling Fluid Bentonite mud Mailing Address PO Box 144 <br /> Depth from Surface Description Linden State CA 1i 95326 <br /> Feet to Feet Describe material rain size color,etc Ci'. <br /> 60 0 Drill,Sample and Install Well to 30'usin Well Location <br /> well materials listed below. Arldress 1601 Turnpike Road <br /> C ly Stockton County San Joaquin <br /> 1-01tudeN Longitude <br /> Dep. Min. Sec. Deq. Min. Sec. <br /> Dntum Decimal Lat. Decimal Long. <br /> AIIN Book 165 Page 040 Parcel 13 <br /> T.Iwnshi Range Section <br /> Location Sketch Activit <br /> -' 'Sketch must be drawn Dy harts after lona is tinted. (D New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> O Destroy <br /> 0<.mb.1.n dv.ens materiels <br /> and,'GEOLOGIC LOG' <br /> Planned Uses <br /> C �\ O Water Supply <br /> \,Cl- ❑Domestic ❑Public <br /> v p T []irrigation ❑Industrial <br /> LU <br /> 0 Cathodic Protection <br /> ' V O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> Monitoring <br /> O Remediation <br /> O Spangling <br /> South O Test Well <br /> III.ay.u�dnceb.a.tenne m..n nom o.m.bmlelNO re�cP= (F Vapor Extraction <br /> r....it..nd.11I em.p.u.e add,.eI pepern nem+een Q Other <br /> ..b....0 %and.an I . <br /> dater Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Ileplh to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 66 Feet I:.stimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 60 Feet -est Length (Hours) Total Drawdown_(Feet) <br /> 'may not be re resentative of a well's Ion term laid. <br /> Casings Annular Material <br /> Depth from BoreholeWall Outside S:.reen Slot Size Depth from <br /> Surface Diameter Type Materiel Thickness Diameter "type if Any Surface Fill Description <br /> Feel to Feet Inches Inches Inches Inches Feet to Feet <br /> 60 58 8 Screen I Sparge Point 1 13/4 1 Micraporus 60 56 Filter Pack #2/16 <br /> 58 0 8 Blank PVC Sch,40 3!4 56 54 Bentonite Chips <br /> 54 0 Cement Portland type 1/II <br /> Attachments Certification Statement <br /> ❑ Geologic Log I,the undersigned,certify that th d 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 Logs) 9245 Beatty Drive Suite A "­-Sacramento CA 95826 <br /> ❑ Soil/Water Chemical Analyses Aagr6ss'-".. City State zip <br /> O Other Site Map Signed4/25/2012 848359 <br /> Attach additional intonation,fit existslicensed wafer IC:'tractor Date Signed C-57 License Number <br /> DWR 188 REV 12008 IF ADDITIONAL SPACE IS NEEDED USE VEXT CONSECUTIVELY NUMBERED FORM <br />