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`The free Adobe Reader may be used to view and completd%wform However,software must be purchased to complir e, sav,,,0d 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 ASW-7 No. e0239341 [� 1 N <br /> Date Work Began 08/25/2014 Date Work Ended 9/4/2014 _ Latitude Longitude <br /> Local Permit Agency San Joaguin CountyEnvironmental Health Department [-L. <br /> 6/30/14 APNlTRS/Other <br /> Permit Number 70176 Permit Date <br /> Geologic Lo __ Well Owner <br /> Orientation @Vertical O Horizontal OAngle Specify. Name San Joag:I n County <br /> Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address I;' 30<1810 <br /> Depth from Surface Description Stockton CA 7i 95201 <br /> Feet to Feet Describe material, rain size,color,etc Cit/ __ State <br /> 65 0 Overdrill 2" __ Well Location <br /> Address 2662 .."ison Way <br /> City Stockton Counly San Joaquin <br /> Lal itude N Longitude <br /> Dea. N n. Sec. Dea- Min. Sec. <br /> Datum JE C.I.at. 37.982692 Dec.Long.-121.271377 <br /> APN Book 117 Page 060 Parcel 33 <br /> Township _Raige Section <br /> Loci o,i Sketch Activit <br /> Sketch must be drat,,by hanj after form isprinted.) Q New Well <br /> tJs Rh 0 Modification/Repair <br /> 0 Deepen <br /> 0 Other <br /> Q Destroy <br /> Describe erocedurea and materials <br /> under'GEOLOGIC LOG" <br /> Planned Uses <br /> Q Water Supply <br /> ❑Domestic []Public <br /> M ❑Irrigation [Industrial <br /> LLI <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> 9 Sparging <br /> S wt, O Test Well <br /> Ln,,,�'U:­ <br /> trele a decribe diatom.aofs ell Irrmroads•buildings•fences, O Vapor Extraction <br /> rs,etc.endattacha ma: Us,a&tional pacer if necessary. O Other <br /> be accurate and.:.,,21 <br /> Water Level anti field 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 DepCn of Completed Well 65 Feet <br /> Tl?st Length _. (Hours) Total Drawdown (Feet) <br /> *DAay not be rept;;se iUi sive of a well's long term yield. <br /> Casings _ Annular Material <br /> Depth from Borehole Wall Outside Screen Slot Si::: :lepth from <br /> Type Material <br /> Surface Diameter Thickness Diameter Type ifAm, Surface Fill Description <br /> Feet to Feet (inches)_ Inches Inches (Inches­ Foet to Feet <br /> Attachments Certific:i:icn litatement <br /> ❑ Geologic Log I,the undersigned,certify that this report is coml,,tte 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, S Ri:I is to Dgrdova CA 95742 <br /> Soil/Water Chemical Analyses Adgrese : City state zip <br /> 13❑� Other Site MoD _ Signed , — �-��""� -' J _ _ 10/31/2014 848359 <br /> Attach additional information Aitezlsts. 7 ied r aor ,,__, Date Signed C-57 License Number <br /> DWR 188 REV.V2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTI',E LY NL IABERED FORM <br />