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'The free Adobe Reader may be used to view and completelw&w6rm. However,software must be purchased to compl:r e, :aVis>✓reuse a saved form. <br /> File Original with 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-7 No. e0239329 [1_ NFTI I <br /> Date Work Began 08/25/2014 Date Work Ended 9/4/2014 _ Latitude Longitude <br /> Local Permit Agency San oaguin COu;tV Environmental Health Department � I I <br /> gpN/T I Other <br /> Permit Number 70176 Permit Date 6/30/14 <br /> Geologic Log Well Owner <br /> Orientation OVertical O Horizontal OAngle Specify Name San Joag:i n _OUnty <br /> Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address j:;2.30.-( 1810 <br /> Depth from Surface Description Stockton CA �i 95201 <br /> Feet to Feet Describe material, rain size,color,etc Cit/ C State <br /> 50 0 Overdrill 4" Well Location <br /> Address 2662 t\,•Wisc�n Way <br /> City Stockton „__• County San Joaquin <br /> Latitude N Longitude _W <br /> Deo. N n. Sec. Dea. Min. Sec. <br /> Datum DEC.Lat. 37.982692 Dec.Long.-121.271377 <br /> APN Book 117 ,•_ Pi;ge 060 Parcel 33 <br /> Toivnship _R2 1 e Section <br /> Loca':olt;iketch Activit <br /> Sketch must be dray,..0 Lan i after form is anted. Q NOW Well <br /> Nr rth 0 Modification/Repair <br /> O Deepen <br /> O Other <br /> Q Destroy <br /> thsaWe procedures antl materiels <br /> under'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> a; o ❑Irrigation ❑Industrial <br /> � w <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> S.,utr O Test Well <br /> Illustrate or describe listen': 17 eg 1 0 Vapor Extraction <br /> -.�m roads.buildings,(coca. O <br /> rive x,etc,and attach a me i Us.ad lionai paper if necasery. Other <br /> Pie;se be accurate and a i.LI-0 a� <br /> inter Level ar l ieid of Completed Well <br /> Depth to first want (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 /> Total Depth of Completed Well 50 Feet <br /> Test Length _, (Hours) Total Drawdown (Feet) <br /> *May not be reprl!se ttalive of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Boreholewall Outside Screen slot S13;r I:epth from <br /> Type Material <br /> Surface Diameter Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inchesl Fret to Feet <br /> Attachments Certifrciuion Matement <br /> ❑Geologic Log 1,the undersigned,certify that this report is comEif to art f accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name All well Abandonment inc. <br /> g Person,Firm or Corporation <br /> ❑ Geophysical Log(s) 3369 Fitzgerald ROad Suite..8==''_,,R r 45 ro Cordova CA 95742 <br /> drBcs '" !.� 1 City State Zip <br /> Ad <br /> ❑ Soil/Water Chemical Analyses .. I <br /> 0 Other Site Mai) Signed ___ 10/31/2014 848359 <br /> Attach additional information fr it e)dstg. a errn or __ Date Signed C-57 License Number <br /> DWR 188 REV.1/2008 IFA DITIONAL SPA6E IS NEEDED,USE t,EXT CONSECUTI\':_Y VUtIBERED FORM <br />