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'The free Adobe Reader may be used to view and complete —> rm. However,software must be pu chased to comp !e, sa,,-,,_ reuse a saved form. <br /> File Original with DWR State of California DWR Use Only—Do Not Fill In <br /> Well Completion Roport [J.-; 1 1 -T �T f-1 <br /> Page 1 Of 1 Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number ASW-3 No. e0239336 E— <br /> Date Work Began 08/25/2014 Date Work Ended 9/4/2014 _ Latitude t Longitude <br /> Local Permit Agency San Joanuin County Environmental Health Department E-1 APNfrRSlO1 <br /> Permit Number 70176 Permit Date 6/30/14 __. <br /> ther <br /> Geologic Lo ,.__. Well Owner <br /> Orientation OVertical O Horizontal OAngle Specify Narne San Joaglt n Cc_unty <br /> Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address_:'' B(tK 1810 <br /> Depth from Surface Description Stockton CA 95201 <br /> Feet to Feet Describe material rain size,color,etc City State I <br /> 65 0 Overdrill 2" _ Well Location <br /> Adiress 2662 „Wscn Way <br /> City Stockton .—County San Joaquin <br /> Lal:itude _ N Longitude _J/V <br /> Dea. N in. Sec. Deq. Min. Sec. <br /> Datum Df C. .at. 37.982692 Dec.Long.-121.271377 <br /> AFN Book 117 ,•_ Page 060 Parcel 33 <br /> Township _Rtl,, a Section <br /> iE-- <br /> Loc..t lo i:?ketch Activity <br /> >ketch must be dra,!r.�Iha:d after form is rimed.) O New Well <br /> Ni rtr O Modification/Repair <br /> O Deepen <br /> O Other <br /> Q Destroy <br /> Oe :procedures and materials <br /> under' EOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> []Domestic ❑Public <br /> Or ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> (E) Sparging <br /> O Test Well <br /> S�)tli <br /> O Vapor Extraction <br /> Illuntrate or desaibe distal:f ol..11 ,m f roads,buildings,fences, <br /> riven.etc.and attach a mf I us f ace itional paper it necessary. O Other <br /> pi asob......teandc:r Ek 1t. <br /> .ter Level anti`'ie 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 /> Test Length _,.__. (Hours) Total Drawdown (Feet) <br /> Total Depth of Completed Well 65 Feet •fgay not be rep, :se ntwive of a well's long term yield. <br /> Casings .. _. <br /> Annular Material <br /> Depth from Borehole Type Material Wall Outside Screen Slot Si::: fiepth from <br /> Surface Diameter Thickness Diameter Type if An,, Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Ffset to Feet <br /> AttachmentsCertific 11 tic n 1;tatement <br /> ❑ Geologic Log I,the undersigned,certify that this report is comb 't( and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name All well Abandonment inc. <br /> 9 Person,Firm or Corporation <br /> 1:1 Geophysical Log(s) 3369 Fitzgerald ROad Suite-DR <br /> _ lc Cordova CA 95742 <br /> ❑ So I/Water Chemical Analyses Addre ;,nrE' State zip <br /> "� 10/31/2014 848359 <br /> ElWOther Site Map Signed <br /> efSate eueootrc� •--- Date Signed C-57 License Number <br /> Attach additional information if it e,dats. �"� ��•• �• <br /> DWR 188 REV.112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTI LY NL'AEEREO FORM <br />