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'The free Adobe Reader maybe used to view and complete*Arfbrm. However,software must be purchased to comp):i=la%,f;,,,,,frreuse a saved form. <br /> File Original w th DWR State of California _ -DWR Use Only-Do Not Fill In <br /> Well Completion Roport _� , <br /> Page 1 of 1 Refer to Instruction Pamphlet State Well NUmber/Site Number <br /> Owner's Well Number ASW-1 No. e0239333 [ L. I I N w <br /> Longitude <br /> Date Work Began 08/25/2014 Date Work Ended 9/4/2914 _ Latitude <br /> Local Permit Agency San Joaauin County Environmental Health Department [ APNIIKwOther <br /> Permit Number 70176 Permit Date 6/30/14 <br /> Geolo is <br /> .09 Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specify Name San Joaq;I:n =u.mty <br /> Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address l;: 3c;(1810 <br /> Depth from Surface Description Stockton __ State CA__Zip 95201 <br /> Feet to Feet Describe material rain size,color,etc Cit l =o <br /> 65 0 Overdrill 2" Well Location <br /> Adljress 2662 N.•W isgn Way <br /> Cit/ Stockton ,•__- County San Joaquin <br /> Latitude N Longitude <br /> Deq. M n. Sec. Deq. Min. Sec. <br /> Datum )ec.I.at. 37.982692 Dec.Long.-121.271377 <br /> APN Book 117 ,._ Finge 060 Parcel 33 <br /> ToA/nship _Re 1 e Section <br /> Loce-:oft Sketch Activit <br /> Sketch must be drat;:.�y hand after form is printed.) Q New Well <br /> Ni rth, O Modification/Repair <br /> O Deepen <br /> O Other <br /> (D Destroy <br /> Gesaibe procedures end materials <br /> under'GEG Cr LGG' <br /> Planned Uses <br /> O Water Supply <br /> [:]Domestic ❑Public <br /> g; ❑Irrigation ❑Industrial <br /> 5 <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> r Test Well <br /> S su <br /> Lease <br /> ordescribe distan:!of%all Ir>m roads,buildings,fences, <br /> O Vapor Extraction <br /> rs,etcand attach a m: Us:ed:tional paper if necessary. O 011ier <br /> be accurate and c:r .,I. <br /> ater Level ami_`'ield of Completed Well <br /> Dapth to first wa,:r-_• (Feet below surface) <br /> Depth to Static <br /> Water Level _,•__• (Feet) Date Measured <br /> Total Dept'1 of Boring 65 Feet Estimated Yield ' __ (GPM) Test Type <br /> Total Deptn of Completed Well 66 Feet Test Length (Hours) Total Drawdown (Feet) <br /> 'May not be rept,!se ita:ive of a well's long term yield. <br /> Casings _ Annular Material <br /> Depth from Borehole Type Material Wall Outside Screen Slot SF: :lepth from <br /> Surface Dlameter yp Thickness Diameter Type if An, Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inche; Filet to Feet <br /> Attachments Certiffc:i:ic n 3tatement <br /> ❑Geologic Log I,the undersigned,certify that this report is coml l !tE at,d accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name All well Abandonment inc. <br /> Person,Firm or Corporation - - <br /> ❑Geophysical Log(s) 3369 Fitz erald ROad I i G if Cbrdova CA 95742 <br /> ❑ So I/Water Chemical Analyses Addrew .. /� City State zip <br /> D Other Site Mal) Signed !;,..- _ 10/31!2014 848359 <br /> Attach additional information n n exists. �,� C- IcensV Wetar�F ,. Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTI' I LY NL IABERED FORM <br />