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state of California <br />Well Completion Report <br />Form DWR188 Submitted 5/18/2022 <br />WCR2022-005579 <br />Owner's Well Number Date Work Began 05/12/2022 Date Work Ended 05/16/2022 <br />Local Permit Agency San Joaquin County Environmental Health Department <br />Secondary Permit Agency Permit Number 43213 Permit Date 04/21/2022 <br />Well Owner (must remain confidential pursuanttb^Water Code 13752). 5 f, / ^Former Use '' - <br />Name Sam & lleene Rith Activity Destroy <br />Mailing Address 4683 Pebble Beach Dr. <br />Former Use Water Supply <br />City Stockton State CA Zip 95219 <br />Well Location . f . <br />Address <br />City Stockton <br />4620 E Shippee LN APN 085-400-09 <br />Latitude <br />Dec. Lat. <br />38 1 <br />Zip <br />38.2839 N <br />95212 <br />Longitude <br />County San Joaquin <br />-121 15 19.0292 W <br />Deg. Min. <br />38.0273011 <br />Sec.Deg. Min. <br />Dec. Long. -121.2552859 <br />Sec. <br />Township <br />Range 07 E <br />Section <br />0 <br />18 <br />2 N <br />Baseline Meridian Mount Diablo <br />Vertical Datum Horizontal Datum WGS84 <br />Ground Surface Elevation <br />Elevation Accuracy <br />Location Accuracy Location Determination <br />Method <br />Elevation Determination Method <br />Bbreholbijlnformation Water teyeliahb <br />Orientation Vertical Specify <br />Drilling Method Drilling Fluid <br />Depth to first water <br />Depth to Static <br />Water Level <br />(Feet below surface) <br />Total Depth of Boring <br />Total Depth of Completed Well 100 <br />Feet <br />Feet <br />Estimated Yield* <br />Test Length <br />(Feet) Date Measured <br />(GPM) Test Type <br />(Hours) Total Drawdown (feet) <br />*May not be representative of a well's long term yield. <br />Destruction Details: <br />No pump in 6in steel casing well. Weil is in a garage. <br />Pumped bentonite from the bottom to the top, cement cap added. <br />As per inspector, holes were drilled in the casing at the floor level of the garage. <br />Other Observations: <br />Form DWR 188 rev. 12/19/2017 Page 1 of 2