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'The free Adobe Reader may be used to view and complet*swr6 form. However,software must be purchased to comp ::e,sa•%,,oId reuse a saved form. <br /> File Original with DWR State of California DWR Use Only—Do Not Fill in <br /> Well Completion Report E J_—;1 <br /> Page 1 of 1 Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number ASW-9 No. e0239345 -* �_ N I II I I t_ w <br /> Date Work Began 08/25/2014 Date Work Ended 9/4/2014 _ _ Latitude Longitude <br /> Local Permit Agency can Joaauin r minty Fnyironmental Health Department APNlf 1 Other <br /> Permit Number 70176 Permit Date 6/30/14 --• <br /> Geologic Lo , Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specify Name San Joaqii n County <br /> Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address_;'�BOK 1810 <br /> Depth from Surface Description Stockton CA 95201 <br /> Feet to Feet Describe material rain size,color,etc City =C State_moi <br /> 65 0 Overdrill 2" Well Location <br /> Adiress 2662 h,.V�is(,n Way <br /> City Stockton ._County San Joaquin <br /> Latitude N Longitude _y\I <br /> Deo. Iv in. Sec. Deo. Min. Sec. <br /> Datum Df c.Lat. 37.982692 Dec.Long.-121.271377 <br /> AFN Book 117 Page 060 Parcel 33 <br /> Township _Rs,1 e Section <br /> Loci t o 1;I ketch Activity <br /> Sketch must be dral:r�Y hani after form isprinted.) O New Well <br /> Nc Ah O Modification/Repair <br /> O Deepen <br /> O Other <br /> Q Destroy <br /> Describe procedures and materials <br /> under'GE0L0Glc LOG' <br /> Planned Uses <br /> 0 Water Supply <br /> ❑Domestic [J Public <br /> a. w ❑Irrigation [:]industrial <br /> 3 <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> 0 Sparging <br /> Slut• Test Well <br /> Illustrate or detaibe distan:!of v eH 1•,m roads.buildings,fences. O Vapor Extraction <br /> dve•t,elc.and ettech a ma: Us ad l lional paper if necessary. O Other <br /> Plena bo accurate and c•i.,L1.1. <br /> iter Level ar c l ield of Completed Well <br /> Depth to first wall) _. (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 /> 'A7ay not be rep !!;e itaiive of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Wali Outside Screen Slot S12;; I;apth from <br /> Surface Diameter Type Material Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches) Fret to Feet <br /> Attachments Certiftcuiion•;Itatement <br /> ❑Geologic Log I,the undersigned,certify that this report is complf to an i accurate to the best of my knowledge and belief <br /> ❑We I Construction Diagram Name All well Abandonment inc. <br /> Person,Firm or Corporation <br /> ❑ Geophysical Log(s) 3369 Fitzgerald Road,Suite'" m " �I ycllo!'ordova CA 95742 <br /> ❑ Soi/Water Chemical Analyses Addr�� �. city Slate zip <br /> Signed ,,�--'l _ 10/31/2014 848359 <br /> ❑r Other Site Mal , . <br /> Attach additlonal information if it exists. -67 Licpgsed" 9. Cor otretT r�..__. Date Si ned C-57 License Number <br /> DWR 188 REV.12006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTI\ :_Y NUIIBERED FORM <br />