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saved <br /> 'The free Adobe Reader maybe used to view and complus form. However,software must be purchased to complete,salad reuse a sae 1.form. <br /> Do Not FIII In <br /> State of California <br /> File Original with DWR Well Completion Report (- f-�T�m r <br /> Page 12 of 16 Rarer to Mail PampnMt $late WBINNUmbef/Sate Number <br /> No. e0150681 _-,�_. L_ 1.. w <br /> Owner's Well Number OW-8 Latitude '1 --� <br /> Date Work Ended alvnnl� <br /> Date Work Began 03/26/2012 -�--Y-�----'- �—�i I I I ' I I <br /> Local Permit Agency San joag <br /> r t Environmental Health DeoartmEoL-. g,NrrRS/ah-' <br /> Permit Number IJe Permit Date 31511?,�— Well Owner <br /> Geologic Lo <br /> Orientation @Vertical O Horizontal OAngle Specify N-.Imo Pen5C0 TfUst CO Cust Etal <br /> Drilling Method Hollow Stem Au er <br /> Drilling Fluid Bentonite mud Mailing Address PO Box 144 <br /> Depth from Surface Description Linden State CA 1 95326 <br /> Feet to Feet Describe material rein size,color,etc C;L'—' yyell Location <br /> 60 0 Drill,Sample and Install Well to 30'Lain <br /> well materials listed below. A:Idress 1601 Turnpike Ro d <br /> City Stockton <br /> County San Joaquin <br /> L'atilude N Longitude Dep. Min. Sac. W <br /> Dap. Min. Sec. <br /> Datum Decimal Lat. Decimal Long. <br /> AIzN Book 165 _ Page 040 Parcel 13 <br /> T:Iwnshi _Rainle— Section <br /> Location Sketch Activit <br /> 'Sketch must be dral by hand afterfonv is nntea Q. New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> — <br /> 0 Destroy <br /> Disoroe y,uceM,ee and melenais <br /> undm'GEOLOGIC LOG' <br /> Planned Uses <br /> Q Water Supply <br /> []Domestic ❑Public <br /> i� ❑Irrigation ❑Industrial <br /> Q Cathodic Protection <br /> O Dewatering <br /> O Heal Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> O Test Well <br /> South @ Vapor Extraction <br /> IIU,:ream ar chai mamep Lave elaa��o ai pzpuVn ne�eceerv.6 Q Other <br /> a:.« <br /> later Level and Yield of Completed Well <br /> Depth to fast water (Feet below surface) <br /> E:epth to Static Feel <br /> y'later Level (Feet) Date Measured <br /> Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Boring 66 <br /> lest Length (Hours) Total Drawdown_(Feet) <br /> Total Depth of Completed Well 60 Feet •Ida not be re resentative of a well's Ion term field. <br /> Casings Annular Material <br /> Depth from Borehole Wall Outside Screen Slot Size Depth From Description <br /> Type Material Thickness Diameter Type if Any Surtace FIII <br /> Surface Diameter Inches Inches Inches Feet to Feet <br /> Feel to Feat Inches ms 60 56 Filler Pack #2/16 <br /> 3/4 Micrrpo <br /> 60 58 8 Screen Sparge Point 56 54 Bentonite Chips <br /> 58 0 8 Blank PVC Sch.40 3/4 54 0 Cement Portland type 1/11 <br /> Certification Statemen <br /> Attachments t <br /> ❑ I,the undersigned,certify that thi:�report is complete and accurate to the best of my knowledge and belief <br /> Geologic Log <br /> ❑WName All Well Abandonment, <br /> Well Construction Diagram <br /> Person,Firm w Corporation CA 9 826 <br /> ❑ Geophysical Log(s) 924E Raattv Drive Suite A Sacramento <br /> Atl17rasL.;, City Stale Zip <br /> ❑ SoillWaterChemical Analyses Signed -�' 4/25/2012 848359 <br /> ❑+ Other Site Mao - C- z L ansa ey, Leu co,vacmr Date Sig ned C-57 License Number <br /> Attach additional informative if it exists. <br /> . IF ADDITIONAL SPACE IS NEEDED.USE SIE%T CONSECUTIVELY NUMBERED FORM <br /> DWR 188 REV12008 <br />