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State of California <br /> Well Completion Report <br /> Form DWR 188 Submitted 9/14/2021 <br /> WCR2021-011734 <br /> Owners Well Number Date Work Began 09/08/2021 Date Work Ended 09/13/2021 <br /> Local Permit Agency San Joaquin County Environmental Health Department <br /> Secondary Permit Agency Permit Number 42150 Permit Date 06/14/2021 <br /> We14.Owner(must;remain conf dential:pursuAnt to Water Gotle 13752) `; former CJse <br /> _ F,.. x.._.. ,3 , <br /> Name Tom Machado Activity Destroy <br /> Mailing Address 12569 S. Escalon Bellota Rd. Former Use Water Supply <br /> City Escalon State CA Zip 9532 <br /> Weil Location . <br /> Address 12569 S Escalon-Bellota RD APN 207-190-32 <br /> City Escalon Zip 95320 County San Joaquin Township 01 S <br /> Latitude 37 51 9.2242 N Longitude -120 59 54.5823 W Range 09 E <br /> Section 16 <br /> Deg. Min. Sec. Deg. Min. Sec. Baseline Meridian Mount Diablo <br /> Dec.Lat. 37.8525623 Dec.Long. -120.9984951 Ground Surface Elevation <br /> Vertical Datum Horizontal Datum WGS84 Elevation Accuracy <br /> Location Accuracy Location Determination Method Elevation Determination Method <br /> gollehole`Information T ;' ' t Watelrlevel and,Yield of Completed Well; <br /> Orientation Vertical Specify Depth to first water (Feet below surface) <br /> Drilling Method Drilling Fluid Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring Feet Estimated Yield' (GPM) Test Type <br /> Test Length (Hours) Total Drawdown (feet) <br /> Total Depth of Completed Well Feet 'May not be representative of a well's long term yield. <br /> Destruction Details: <br /> Abandoned old 8in steel casing well approximately 138ft deep.Pulled pump,then pumped bentonite from the bottom to the top with bentonite.Capped the <br /> well with cement as per the county. <br /> Other Observations: <br /> Form DWR 188 rev. 12/19/2017 Page 1 of 2 <br />