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State of California <br />Well Completion Report <br />Form DWR 188 Submitted 7/20/2021 <br />WCR2021-009046 <br />Owner's Well Number Date Work Began 12/30/2020 <br />Local Permit Agency San Joaquin County Environmental Health Department <br />Secondary Permit Agency Permit Number WP0041284 <br />Well Owner (must remain confidential pursuant to Water Code 13752) <br />Name DAN JOHNSON <br />Mailing Address 29855 ORANGE AVE <br />City ESCALON State CA Zip 95320 11 <br />Well Location <br />Date Work Ended 12/30/2020 <br />Permit Date 09/30/2020 <br />Former Use <br />Activity Destroy <br />Former Use Water Sum* <br />Address 29855 ORANGE AVE APN 249-180-090 <br />City ESCALON Zip 95320 County San Joaquin Township 02 S <br />24.5316 N Longitude -120 56 36.0888 W Range 09 E <br />Section 11 <br />Sec. Deg. Min. Sec. <br />Baseline Meridian Mount Diablo <br />Dec. Long. -120.943358 Ground Surface Elevation 148 <br />Horizontal Datum WGS84 Elevation Accuracy Unknown <br />Location Determination Method GPS Elevation Determination Method <br />Latitude 37 46 <br />Deg. Min. <br />Dec. Lat. 37.773481 <br />Vertical Datum <br />Location Accuracy Unknown <br />Borehole Information <br />Water Level and Yield of Completed Well <br />Orientation Vertical Specify <br />Depth to first water (Feet below surface) <br />Depth to Static <br />Drilling Method Drilling Fluid <br />Water Level 0 (Feet) Date Measured 12/30/2020 <br />Estimated Yield* (GPM) Test Type <br />Total Depth of Boring Feet <br />Test Length (Hours) Total Drawdown (feet) <br />Total Depth of Completed Well 30 Feet <br />May not be representative of a well's long term yield. <br />Destruction Details: <br />FILLED WITH BENTONITE AND TOPPED WITH A 3FT MUSHROOM CAP <br />Other Observations: <br />Form DWR 188 rev. 12/19/2017 Page 1 of 2 <br />