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'The free Adobe Reader may be used to view and completi However,software must be purchased to complete,as*reuse a saved form. <br /> File Original with DWR <br /> State of California DWR Use only—Do Not Fill In <br /> Well Completion Report = — <br /> b <br /> Page 2 of 16 Refer to instruction Perini I Sta[e Well Numer/Site Number W <br /> N <br /> Owner's Well Number VW-2 d/9/9019 No. e0150665 L LeliLon itude <br /> Date Work Began 03/26/2012 Date Work Ended4/3/2012 <br /> Permit Agency JoapLin Col_nt Environmental Health Department I I I A <br /> Permit Number NA Permit Date 3/5/12 <br /> Geolo i7nta <br /> Well Owner <br /> Orientation O Vertical O Horizo0Angle Specify Name Pensco Trust Co Cust Etal <br /> Drilling Method Hallow Stem Auger Drilling Fluid Bentonite mud M ailing Address PO Box 144 <br /> Depth from Surface scription Cit Linden State CA li 95326 <br /> Feel to Feel Describal, rain size,color,etc <br /> 20 0 Drill,Sample and Install VW-J,Jo 20 usin . <br /> WewSection <br /> well materials listed below. Address 1601 Turnpike RoaJoaquin <br /> City Stockton <br /> L:Ititude __—WDooMin. Sec . Min. Sec.Datum Decimal Lal. llong.APN Book 165 Page 0413Townshi Ran a <br /> 7ha ,eC, <br /> tch Z' —J <br /> iv <br /> tterfom is ranted l <br /> ion/Repair <br /> en <br /> Other— <br /> 0 <br /> <edm.e and memneie <br /> OGIG LOG' <br /> Planned Uses <br /> O Water Supply_ ❑Domestic ❑Publicw ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> 0 Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> 0 Test Well <br /> South <br /> Vapor Extraction <br /> nwavatm.ne.necn alm;p uaaidauppride <br /> +i voe naneoaa4.aa�a Je O Other <br /> ni�.aaaee a«mr.and—place <br /> hater Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 20 Feel Estimated Yield (GPM) Test Type <br /> 1 est Length (Hours) Total Drawdown_(Feet) <br /> Total Depth of Completed Well 20 Feet *'Aav not be re resentative of a well's long term yield. <br /> Casins Annular Material <br /> Depth from Borehole Type Material Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Thickness Diameter lips If Any Surface FIII Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feel <br /> 20 5 8 Screen PVC Soh.40 4 Mille Slots 0.0202) 3 Filter Pack #3 <br /> 5 1 8 Blank PVC Sch.40 4 3 1 Bentonite Chips <br /> 1 0 Cement Portland type 1/II <br /> Attachments Certification Statement <br /> ❑ Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑WName All Well Abandonment, <br /> Well Construction Diagram <br /> Parson,Firm or Corporation❑ Geophysical Lag($) 9245 Beatty Drive Suite A Sacramento CA 95826 <br /> Aaares ✓— City State Zip <br /> ❑ SoiVWater Chemical Analyses Signed "� - �"% 4/25/2012 848359 <br /> I] Other Site M4 censetl araClOr <br /> Date Signed C-57 License Number <br /> Attt57 elerW211 Cc <br /> WR 1 additional8RVirtlarmetion it it exists, <br /> DWR taa REV.12006 IF ADDITIONAL SPACE IS NEEDED.USE h'E%T CONSECUTIVELY NUMBERED FORM <br />