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State of California <br />Well Completion Report <br />Form DWR 188 Submitted 5/1212022 <br />WC112022-005401 <br />Owner's Well Number Date Work Began 04/22/2022 <br />Local Permit Agency San Joaquin County Environmental Health Department <br />Secondary Permit Agency <br />Permit Number WP0043153 <br />Date Work Ended 04/22/2022 <br />Permit Date 04/06/2022 <br />Well Owner (must remain confidential pursuant to Water Code 13752) <br />Former Use <br />Name STACI SILVA <br />Activity Destroy <br />Former Use Water Supply <br />Mailing Address 25932 MILLER AVE <br />City ESCALON State CA Zip 95320 <br />Depth to Static <br />Drilling Method Drilling Fluid <br />Well Location <br />Address 25932 MILLER AVE <br />City ESCALON Zip 95320 County San Joaquin <br />Latitude 37 48 12.798 N Longitude -120 59 29.6232 W <br />Deg, Min. Sec, Deg, Min, Sec. <br />Dec. Lat. 37.803555 Dec. Long. -120.991562 <br />Vertical Datum Horizontal Datum WGS84 <br />Location Accuracy Location Determination <br />Method <br />APN 227-040-090 <br />Township 01 S <br />Range 09 E <br />Section 33 <br />Baseline Meridian Mount Diablo <br />Ground Surface Elevation 126 <br />Elevation Accuracy <br />Elevation Determination Method Digital Aerial Photo <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 75 (Feet) Date Measured 04/22/2022 <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 80 Feet <br />*May not be representative of a well's long term yield. <br />Destruction Details: <br />WELL DESTROYED 04.22.2022 <br />25932 MILLER AVE HAS HOOKED UP TO CITY OF ESCALON WATER <br />Other Observations: <br />OBSERVED BY COUNTY INSPECTOR 04.22.2022 <br />P"16`11 `i R 2022 <br />.-I�!VIRUNMEiJI/aL HE/aL�l I-1 <br />�= f=F:MITIS1=f��/ICES <br />Form DWR 188 rev. 12/19/2017 Page 1 of 2 <br />