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'The free Adobe Reader may be used to view and complett.r form. However,software must be purchased to comp ::e,sa XL Ad reuse a saved form. <br /> File Original with DWR State of California -- DWR Use Only—Do Not Fill In <br /> Well Completion Report I II I -]-I--T� <br /> Page 1 Of 1 Refer to Insirodion Pamphlet <br /> _ State Well Number/Site Number <br /> Owner's Well Number ASW-8 No. e0239343W <br /> Date Work Began 08/25/2014 Date Work Ended 9/4/2014 _ C�_ Latitude t I I Longitude <br /> Local Permit Agency San Ioaauin County Environmental Health Department [�. <br /> Permit Number 70176 Permit Date 6/30/14 „__ APN/TRS/Other <br /> Geologic Lo _ Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specify Name San Joaotlin C;untV <br /> Drilling Method Hollow Stem Au er Drilling Fluid Mailing Address_;'D Box 1810 <br /> Depth from Surface Description Stockton CA 7 95201 <br /> Feet to Feet Describe material, rain size,color,etc City ____ State 1 <br /> 65 0 Overdrill 2" Well Location <br /> Address 2662 isi;n Way <br /> City Stockton .,_ County San Joaquin <br /> La:itude N Longitude �N <br /> Deq. h in. Sec. Deq. Min. Sec. <br /> Datum , Die. _at. 37.982692 Dec.Long.-121.271377 <br /> APN Book 117 ,-_ Page 060 Parcel 33 <br /> Township _E!ii a Section <br /> Loci,t io t! ketch Activity <br /> Sketch must be dra!r.�)ha;d after form isprinted.) O New Well <br /> ,.Nllrtt, O Modification/Repair <br /> O Deepen <br /> O Other <br /> Q Destroy <br /> Describe procedures end materials <br /> under'GEOLOGtC LOG' <br /> Planned Uses <br /> O Water Supply <br /> []Domestic []Public <br /> al o ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> I Sparging <br /> S 1uYTest Well <br /> Illtn trate or describe distan,:ors ell 1 rm roads.buildings,fences, O vapor Extraction <br /> rivers.etc.and attach a me:.Us:adi tional paper it necessary. O Other <br /> Fie ase be accurate and c <br /> Water Level arid field of Completed Well <br /> Depth to first wa,-! (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 /> 'flay not be reps y se its ive of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Type Material Wall Outside Screen Slot Si;:1 I:epth from <br /> Surface Diameter yp Thickness Diameter Type if Anj Surface Fill Description <br /> Feet to Feet Inches Inches Inches (inches;. Fret to Feet <br /> Attachments Certificil t io n_Eitatement <br /> ❑ Geologic Log I,the undersigned,certify that this report is comr f to art J 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 ;." 'l!cit;o�!;ordova CA 95742 <br /> ❑ Soi/Water Chemical Analyses Address ,�* �' City State Zip <br /> �. !° <br /> I]Other Site Map Signed _ 10/31/2014 848359 <br /> Attach additional intortnation it it a asts. a er Vi gGw tGacforr ,__ Date Si ned C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEI D,USE NEXT CONSECUTIV`_Y 14WISERED FORM <br />