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State of California <br />Well Completion Report <br />Form DWR 188 Submitted 1/26/2021 <br />WCR2021-000959 <br />Owner's Well Number Date Work Began 12/21/2020 <br />Local Permit Agency San Joaquin County Environmental Health Department <br />Secondary Permit Agency Permit Number WP0041528 <br />Well Owner (must remain confidential pursuant to Water Code 13752) <br />Name KASMER BARACOSA <br />Mailing Address 5888 E VERIGAN RD <br />Date Work Ended 12/21/2020 <br />Permit Date 12/14/2020 <br />Former Use <br />Activity Destroy <br />Former Use Water Suooly <br />City MANTECA State CA Zip 95336 11 1 <br />Well Location <br />Address 5888 E VERIGAN RD APN 197-120-430 <br />City MANTECA Zip 95336 County San Joaquin Township <br />Latitude 37 50 20.2343 N Longitude -121 12 38.8404 W Range <br />Section <br />Deg. Min. Sec. Deg. Min. Sec. <br />Baseline Meridian <br />Dec. Lat. 37.838954 Dec. Long. -121.210789 Ground Surface Elevation 55 <br />Vertical Datum Horizontal Datum WGS84 Elevation Accuracy Unknown <br />Location Accuracy Unknown Location Determination Method Other 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 50 (Feet) Date Measured 12/21/2020 <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 50 Feet <br />*May not be representative of a well's long term yield. <br />Destruction Details: <br />WELL FILLED WITH BENTONITE AND CAPPED OFF COMPLETE WITH A 3' MUSHROOM CAP <br />INSPECTED BY: SAN JOAQUIN COUNTY <br />Other Observations: <br />Form DWR 188 rev. 12/19/2017 Page 1 of 2 <br />