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State of California <br />Well Completion Report <br />Form DWR 188 Submitted 8/15/2022 <br />WCR2022-009508 <br />Owner's Well Number Date Work Began 12/01/2021 <br />Local Permit Agency San Joaquin County Environmental Health Department <br />Secondary Permit Agency Permit Number WP0042769 <br />Well Owner (must remain confidential pursuant to Water Code 13752) <br />Name KAREN VIEIRA <br />Mailing Address 16896 ELSHOLZ RD. <br />City RIPON State CA Zip 95366 I I <br />Well Location <br />Date Work Ended 12/02/2021 <br />Permit Date 12/01/2021 <br />Former Use <br />Activity Destroy <br />Former Use Water Supply <br />Address 17093 ELSHOLZ RD APN 203-220-040 <br />City RIPON Zip 95366 County San Joaquin Township 01 S <br />Latitude 37 48 34.1244 N Longitude -121 6 0.3599 W Range 08 E <br />Section 33 <br />Deg. Min. Sec. Deg. Min. Sec. <br />Baseline Meridian Mount Diablo <br />Dec. Lat. 37.809479 Dec. Long. -121.1001 Ground Surface Elevation 73 <br />Vertical Datum Horizontal Datum WGS84 Elevation Accuracy Unknown <br />Location Accuracy >50 Ft Location Determination GPS Elevation Determination Method Digital Aerial Photo <br />Method <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 12/02/2021 <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 Feet <br />*May not be representative of a well's long term yield. <br />Destruction Details: <br />6" WELL DESTRUCTION <br />Other Observations: <br />COUNTY INSPECTOR FRANK <br />Form DWR 188 rev. 12/19/2017 Page 1 of 2 <br />