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'The free Adobe Reader may be used to view and complete form. However,software must be purchased to comp,:.e,sa,11-�reuse a saved form. <br /> File Original with DWR State of California _ DWR Use Only-Do Not Fill In <br /> Pae 1 of 1 Well Completion Report [J. �-I I I I <br /> Page Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number ASW-6 No. e0239339 [1 N w <br /> Date Work Began 08/25/2014 Date Work Ended 9/4/2014 _ _ Latitude Lon itude <br /> Local Permit Agency San Joaauin County Environmental Health Department [�. <br /> Permit Number 70176 Permit Date 6/30/14 „__ APN/TRS/Other <br /> Geologic Lo Well Owner <br /> Orientation OVertical O Horizontal OAngle Specify Name San Joaawn Crunty <br /> Drilling Method Hollow Stem Auger Drilling Fluid <br /> Mailing Address_"D BLIX 1810 <br /> Depth from Surface Description Stockton CA 95201 <br /> Feet to Feet Describe material, rain size,color,etc City State f—_ <br /> 65 0 Overdrill 2" Well Location <br /> Address 2662 I,V1 ist,n Way <br /> City Stockton ,._ County San Joaquin <br /> La:itude N Longitude _may <br /> Deg. A in. Sec. Deo. Min. Sec. <br /> Datum Die. -at. 37.982692 Dec.Long.-121.271377 <br /> AFIN Book 117 •,_ Fage 060 Parcel 33 <br /> Township _REIn a Section <br /> Local io i ketch Activity <br /> Sketch mus!be dra;r IN ha"d after form isprinted.) —0—New Well <br /> N trth 0 Modification/Repair <br /> O Deepen <br /> O Other <br /> (D Destroy <br /> Describe procedures and materials <br /> under'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> _ a ❑Irrigation ❑industrial <br /> Lu O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> * Sparging <br /> S)uill O Test Well <br /> Illuatrale or describe distar 11 1.e of•ell i om roads,buildings,fences, O vapor Extraction <br /> rivers,etc.and attach a mr I• us f acr itional paper if necessary. O Other <br /> Please be accurate and c I r PM to., <br /> ater Level alit)"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 /> Total Depth of Completed Well 65 Feet <br /> Test Length __. (Hours) Total Drawdown (Feet) <br /> atAay not be rep sentalive of a well's long term yield. <br /> Casings __ Annular Material <br /> Depth from Borehole Type Material wall Outside Screen Slot Si::E [Iepth from <br /> Surface Diameter Thickness Diameter Type if Am, Surface Fill Description <br /> Feet to Feet Inches inches Inches Inches• Foet to Feet <br /> Attachments Certificmic n>tatement <br /> ❑ Geologic Log I,the undersigned,certify that this report is comlll!tE and 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 Fitzaerald Road,SO BR.:! ,to,Cordova CA 95742 <br /> ❑SoI/WaterChemical Analyses Add - ���IF"s City Slate zp <br /> O Other Site Map Signed �"! �"- _ _ 10/31/2014 848359 <br /> Attach additional information.H it exists. Lic tt one cror __, Date Signed C-57 License Number <br /> rtn <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED.USE NEXT CONSECUTI' E LY NL IABERED FORM <br />