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"The free Adobe Reader may be used to view and comt- 'his form.,However,software must be purchased to complete,:~ �nd reuse a saved form. <br /> Fite Original with DWR "111W State of California <br /> -70 <br /> Page 18 of 18 . Well Completion Report <br /> Reterto rnstrucdon Pamphlet <br /> Owners Well Number IW-5 No. e0150794 Stateweu NumbedsHe Number j <br /> Date Work Began 04/12/2012 Date Work Ended N w <br /> Local Permit AgencyLatitude Lon ltude <br /> - a <br /> Permit Number 15502Q64Permit Date 2129112 APNrTR510ther <br /> Ostentation O Vertical O Horizontal OAngle $pettiFy <br /> Drilling Method Au er -Name Wight Holdin s Inc. <br /> Drilling Fluid <br /> 9 _ Mailing Address .1 0 S.Wilson Way <br /> o C Stockton State C_.A iD 95205 . <br /> D fi5 Overdrill 314 inch well to fi5 feet: <br /> Address 1 0 S.'Wilson Way �_ ;, <br /> City tockt �� San Joa uin <br /> Latitude _=„�N }'o�gttu � w <br /> Datum Decimal La' < b .DeCimal. ang. i <br /> APN Book Page M€: Parcel <br /> Township '� -;Ran Se&Jon � <br /> ON W Well:: <br /> �77rr5w9r AA (0 Mo6ificatiotVRepair <br /> >` .0 Deepen <br /> .. 0 Other <br /> Destroy <br /> DewA'PraceCuies and maferials <br /> �• wder'GEOLOGFC LOG' <br /> 0 Water Supply <br /> Y x � ❑Domestic [Z]Public <br /> W ;' El Irrigation ❑Industrial <br /> ,il .. O Cathodic Protection <br /> O Dewatering <br /> ' 0 Heat Exchange <br /> A 0 injection <br /> �£ 0 Monitoring <br /> O Remediation <br /> r9. <br /> O S a In <br /> P 9 <br /> 41- <br /> .,f. .r South0 Test Well <br /> 136*21e w Oe=lbe dlstanoe of wall from rosea,bug.dips,rerzaa, O Vapor Extraction <br /> - rivers,etc,ane ahaah a map.Use awbonal paper H neoesearr. 0 Oder <br /> accurate VW c <br /> w eR <br /> All <br /> r -c <br /> ..c,a <br /> 4 Depth to first water (Feel below surleoe) <br /> Depth to.Static <br /> - * Water Level (Feet) Date Measured <br /> LTotalh of Boring aa6 1q Feet Estimated Yield" {GPM) Test Type <br /> _1 ,h ofompleted Well ' Feet Test Length (Hours) Total Drawdown (Feet) <br /> �_ <br /> *May not be representative of a well's Ion term yield. t <br /> Depth from tehole Wall Outside Screen Slot Size Depth from ' <br /> Surface Diirrf[tteV ,,� ] Ilaterf�l Thickness Diameter Type <br /> If <br /> Feet Feet Incites Inches Inches !nches Surface Feeto Feel Fill Description <br /> Ak <br /> 76 k <br /> ❑Geologic Log I,the undersigned,certify that this report is Complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name sca �)Plljna.L.P. <br /> ❑Geophysical Log(s) Person,Flan o,Carpora,,In <br /> rnec Ci le Rancho Cordova CA 95742 <br /> ❑Soil/Water Chemical Analyses dr8 cityP . <br /> 0 Other Site May Signed 4/26/2092 938110 . I <br /> Attach additional intmmation If it eA ts. C-57 Licensed Water . Date Signed C-57 Lipense Number <br /> OWR 188 REV.1!2008 IF ADDITIONAL SPACE I5 NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> : I <br /> k: <br /> . 'I <br />