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.r <br /> 'The free Adobe Reader may be used to view and complete\, Aorm. However,software must be purchased to compl:t a, aa%+�reuse a saved form. <br /> File Original w th DWR State of California DWR Use Only-Do Not Fill In <br /> Well Completion Report <br /> Page 1 Of 1 Refer to instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number VEW-6 No- e0239328 -L. I I NI I I I W <br /> Date Work Began 08/25/2014 Date Work Ended 4/4/2014 _ Latitude Longitude <br /> Local Permit Agency San InaQUJn r...,.,t.+GnvirnnmantaI Health Department APNIfRS/Other <br /> Permit Number 70176 Permit Date 6/30/14 <br /> Geologic Log Well Owner <br /> Orientation OVertical O Horizontal OAngle Specify Name San Joaga n _aunty <br /> Drilling Method Hollow Stem!ggr Drilling Fluid Mailing Address l;' 3a c 1810 <br /> Depth from Surface Description Stockton — State Cp zi 95201 <br /> Feet to Feet Describe material, rain size,color,etc City <br /> 50 0 Overdrill 4" _— Well Location <br /> Address 2662 b,_"isrn Way <br /> City Stockton •__—, County San Joaquin <br /> Latitude _ N Longitude _yV <br /> Dea. Nin. Sec. Deo. Min. Sec. <br /> Datum De c.I-at. 37.982692 Dec.Long.-121.271377 <br /> AFN Book 117 .._ Page 060 Parcel 33 <br /> Township —Rai a Section <br /> Loco: t io t ketch Activity <br /> Sketch must be dra!r b)ha;tl after forth is rioted. 0 New Well <br /> „Nortt O Modification/Repair <br /> O Deepen <br /> O Other <br /> O Destroy <br /> DescriDa procedures and materials <br /> under'GEOLOGIC LOG' <br /> Planned Uses <br /> Q Water Supply <br /> []Domestic ❑Public <br /> W ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> O Test Well <br /> S 3ui I I <br /> _---�•--• �Vapor Extraction <br /> LPk <br /> strate or describe distal:r of roll 5 om roads,buildings,fences. O <br /> aa,etc.and anach a mi ut a at itional paper if necessary. Other <br /> ase beaccurate and c r+ tom. <br /> hater Level at,I I"icll_d of Completed Well <br /> Depth to first wal:r,—• (Feet below surface) <br /> Depth to Static <br /> Water Level —,•--• (Feet) Date Measured <br /> Total Depth of Boring 50 Feet Estimated Yield' _—, (GPM) Test Type <br /> Test Length _.._—. (Hours) Total Drawdown (Feet) <br /> Total Depth of Completed Well 50 Feet 'May not be rep °SEntalive of a well's Ion term field. <br /> — <br /> Annular Material <br /> Casin s <br /> Depth from Borehole Material Wall Outside Screen Slot Si!( depth from <br /> Diameter Type if An I Surface <br /> Surface Diameter Type Thickness DiFill Description <br /> Inches Inches Inche:al Fret to Feet <br /> Feet f reef Inches <br /> Attachments Certificilti(In statement <br /> ❑ Geologic Log I,the undersigned,certify that this reportis com:I9and ad accurate to the best of my knowledge and belief <br /> 13 Well Construction Dia ram Name All well Abandonment inc. _ <br /> g Person,Finn or Corporation <br /> F-1Geophysical Log(s) 3369 Fitzgerald ROad,_S�!B R:I :�,Cordova CA 95742 <br /> City State Zip <br /> ❑ Sail/Water Chemical Analyses Signed A l' 10/31/2014 848359 <br /> O Ot,er Site Map <br /> r �' <br /> Attach additional information,If it exists. <br /> 11 F 6 c ,.--, Date Signed C-57 License Number <br /> rm <br /> DWR 188 REV.112oD6 IF ADDITIONAL STPACE IS NEED ,USE VEXT CONSECUTI r':L: NUMBERED FORM <br />