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'The free Adobe Reader maybe used to view and complus form. However,software must be purchased to complete.Sa d reuse a saved form. <br /> State of California MLtt.Sd <br /> l -Do Not FIII In <br /> File Original with DWR T <br /> Well Completion Report <br /> Page 14 of 16 Rarerro mswcrion Pempnnrtmbar/Snel Number W <br /> Owner's Well Number OW-10 No. e0150683 <br /> Date Work Ended ,9($/ 012 Lon itude <br /> Date Work Began 03/26/2012 — <br /> LoralPermitAgencyyCgO,loapuin CoLnty Environmental Health DepartmentTRs/aher <br /> Permit Number NA Permit Date 3/5/12 <br /> Well Owner <br /> Geologic Lo <br /> Orientation OVertical O Horizontal OAngle Specify [Name Pensco Trust Co Cust EtaDrillingMethod HollowStemAu er Drilling Fluid Bentonite mud ailing Address PO Box 144 <br /> Depth from Surface Descrption t Linden StateCA 7ip 95326 <br /> Feet to Feet Describe material, rain size,color,etc <br /> 60 0 Drill,Sam le and Install Well to 30'usin Well Location <br /> well materials listed below. Address 1601 Turnpike Road <br /> C ty Stockton County San Joaquin <br /> Latitude N Longitude __Min. <br /> Duo Min. Sec. Dec. Sec. <br /> Datum Decimal Lat. Decimal Long. <br /> APN Book 165 Page 040 Parcel 13 <br /> Townshi Ran a Section <br /> 7r1h <br /> on Sketch Activit <br /> Sketohb hand after IDmiis rimed. O. New Well <br /> North 0 Modification/Repair <br /> 0 Deepen <br /> O Other <br /> — <br /> 0 Destroy <br /> D...I,.........nd mama. <br /> „rid.,caotactc�oc <br /> Planned Uses <br /> 0 Water Supply <br /> []Domestic ❑Public <br /> m [-]Irrigation ❑Industrial <br /> `I 0 Cathodic Protection <br /> ,, �ri/ 0 Dewatering <br /> 1�V' 0 Heat Exchange <br /> 0 Injection <br /> 0 Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> 0 Test Well <br /> South �Vapor Extraction <br /> ti <br /> u.•ead�n�ai oav,f eces1a(ys. 0OtherFi.a,.Emets. <br /> dater Level and Yield of Completed Well <br /> I.repth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 66 Feet I.Stimated Yield' (GPM) Test Type <br /> ".'est Length (Hours) Total Drawdown_(Feet) <br /> Total Depth of Completed Well 60 Feet 'Ma not be re resentative of a well's long term vield. <br /> Casin s Annular Material <br /> Depth from Borehole Wall Outside S:T$Iot Depth fromSurface Diameter Type Material Thickness Diameter 'TSurface Fill Description <br /> Feet to Feet Inches Inches InchesFeet to Feet <br /> 60 58 8 Screen Sparge Point 3/4 Mico60 56 Filter Pack #2/16 <br /> 58 0 8 Blank PVC Sch.40 3/456 54 Bentonite Chips <br /> 54 0 Cement Portland type 1/II <br /> Attachments Certification Statement <br /> CJ Geologic Log 1,the undersigned,certify that In 5 report is complete and accurate to the best of my knowledge and belief <br /> [:J Well Geologic <br /> Log <br /> Diagram Name All Well Abandonment, <br /> g Person Firm or Corporation <br /> ❑ Geophysical Log(s) 9245 Beatty Drive Suite A �� r mento CA 95826 <br /> Atldress" �— City Siete Zip <br /> ❑ Other Site <br /> Chemical Analyses -- 4/25/2012 848359 <br /> ❑� Other Site MaD Signetl <br /> Attach additIM81 Iraomtelon if a exists. <br /> C-57 L tensed Weler Weil C�nlractor Date Signed C-57 License Number <br /> DWR 188 REV.12006 IF ADDITIONAL SPACE IS NEEDED.USE VEXT CONSECUTIVELY NUMBERED FORM <br />