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'The free Adobe Reader may be used to view and complel! s form. However,software must be purchased to comp)1,a, ;a V0*hd reuse a saved form. <br /> File Original with DWR State of California _ DWR Use Only-Do Not Fill In <br /> 1 Well Completion Report <br /> Page 1 Of Refer to Instruction Pamphlet _ State Well Number/Sete Number <br /> Owner's Well Vumber ASW-2 No. e0239335 ComN i__i__� _ w <br /> . � I <br /> Date Work Began 08/25/2014 Date Work Ended 9/4/2014 _ _ Latitude Longitude <br /> Local Permit Agency ` '^^^'p^tel Naalth Denartment C-1. APN/T I Other <br /> Permit Number 70176 Permit Date 6/30/14 <br /> Geologic LogWell Owner <br /> Orientation Oa Vertical O Horizontal OAngle Speciry Name San Joagit n County - <br /> Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address_:' 3CI{ 1810 <br /> Depth from Surface Description Stockton State CA�i 95201 <br /> Feet to Feet Describe material rain size,color,etc City ==t <br /> 65 0 Overdrill 2" _— Well Location <br /> Address 2662 „V�is(;n Way - <br /> City Stockton County San Joaquin <br /> Latitude N Longitude <br /> Deo. N in. Sec. Deq. Min. Sec. <br /> Datum Dec. _at. 37.982692 Dec.Long.-121.271377 <br /> APN Book 117 „_ Page 960 Parcel 33 <br /> Township _Rsl i e Section <br /> Loc..tio1 ketch Activit <br /> Sketch must be dra 1 r b!ha;d after form isprinted.) 0 New Well <br /> ,.N,rtt 0 Modification/Repair <br /> O Deepen <br /> O Other <br /> Q Destroy <br /> Describe procedures and materials <br /> under*GEOLOGIC LOG• <br /> Planned Uses <br /> Water Supply <br /> ❑Domestic ❑Public <br /> ❑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 /> S)ufl1 O Test Well <br /> -- <br /> Lase <br /> lVate or describe distar i e of-rell Yom roads,buildings.kO Vapor Extraction <br /> nees,rs,etc.andattacham1i. Utt t acr itional paper if necessary. O Other <br /> be accurate and c i t!e tt. <br /> ater Level ali;l"ic: d of Completed Well <br /> Depth to first wa::r- (Feet below surface) <br /> Depth to Static <br /> Water Level — (Feet) Date Measured <br /> Total Depth of Boring 65 Feet Estimated Yield ' _— (GPM) Test Type <br /> Total Depth of Completed well 65 Feet Test Length _..--• (Hours) Total Drawdown (Feet) <br /> `May not be rep >SEntulive of a well's long term yield. <br /> Casings _ Annular Material <br /> Depth from Borehole Type Material Wall Outside Screen Slot SI.IE flepth from <br /> Surface Diameter Thickness Diameter Type if An•I Surface Fill Description <br /> Feet to =eet Inches Inches Inches Inche o F,.-et to Feet <br /> Attachments Certificittic,n itatement <br /> ❑ Geologic Log I,the undersigned,certify that this report is coml:l ate a,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 Fitzgerald Road, Suite B R;,1@wQordcva CA 95742 <br /> ❑ Soil/WaterChemical Analyses Address ^ ,.,wCuy state Zip <br /> 0 Other Site Mai Signed .-�"�': _ 10/31/2014 848359 <br /> Attach additional iMtxmation if it exists. .G5F watefWell Contractor t_ Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE 14EXT CONSECUTI.1.Ll NLI ABERED FORM <br />