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'The free Adobe Reader may be used to view and complete this form. However,software must be purchased to complete,save,and reuse a saved form. <br /> File Original with DWR State of California DWR Use Only—Do Not Fill In <br /> Well Completion Report <br /> Page 1 Of 1 Refer to Instruction Pamphlet <br /> State Well Number/Site Number <br /> Owner's Well Number WP0038808 No. <br /> XXXXXXX <br /> I i <br /> Date Work Began 09/24/2018 Date Work Ended 10/1/2018 Latitude N Longitude I w <br /> Local Permit Agency San Joaquin <br /> Permit Number WP0038808 Permit Date 9/21/18 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specify Name Dwight Mitchell <br /> Drilling Method Direct Rotary Drilling Fluid Bentonite mud <br /> Mailing Address 2812 Pacific Ave <br /> Depth from Surface Description <br /> Feet to Feet Describe material, rain size,color,etc Cit Stockton State Ca Zi <br /> 0 6 TOP Soil Well Location <br /> 6 24 Clay Address 1246 Fine Rd <br /> 24 40 Gravel City Linden County San Joaquin <br /> 40 63 Sand Latitude N Longitude _yV <br /> 63 79 Sand Gravel Deo. Min. Sec. Dec. Min. Sec. <br /> 79 92 Sand Datum Dec.Lat. Dec.Long. <br /> 92 124 Clay APN Book Page Parcel <br /> 124 136 sand -Township —Range Section <br /> 136 166 Clay Location Sketch Activity <br /> 166 196 Sand Skeich must be drawn b hand after form is printed.) Oi New Well <br /> North O Modification/Repair <br /> 196 214 Shale O Deepen <br /> 214 236 Sand O Other <br /> 236 252 Clay O DeesStbe procedures and materials <br /> 252 272 Gravelunder'GEOLOGIC LOG' <br /> 272 300 Black sand C E I Planned Uses <br /> O Water Supply <br /> H MAR !. 2019 n N ❑Domestic []Public <br /> 7 U IJ W ❑Irrigation ❑Industrial <br /> rNVIRONMENTAL HEALTH O Cathodic Protection <br /> PFRMIT/SEMACFS O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> Illustrate or describe distance of well from roads,buildings,fences, <br /> O Vapor Extraction <br /> rivers,etc.and attach a map.Use additional paper iF necessary. O Other <br /> Please be accurate and com late. <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 300 Feet Estimated Yield* 20 (GPM) Test Type <br /> Total Depth of Completed Well 300 Feet Test Length (Hours) Total Drawdown (Feet) <br /> *Ma not be representative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole T e Material wall Outside Screen Slot Size Depth from <br /> Surface Diameter yp Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 1 280 12 Blank PVC Sch.80 6 1 118 Bentonite <br /> 280 300 12 Screen PVC Sch.80 6 118 300 Filter Pack Grit Sand Gravel <br /> Attachments Certification Statement <br /> ❑ Geologic Log 1,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑ Well Construction Diagram Name Points West Drilling <br /> Person,Firm or Corporation <br /> ❑ Geophysical Log(s) P.O Box 162 / West Point CA 95255 <br /> ❑ Soil/Water Chemical Analyses edress f .. 'ZlcityState Zip <br /> ❑ Other Signed ]/,�,L i_ / _D5?/2018 433493 <br /> Attach additional information if it exists. 13-'S7/2icensecl Water Well Contractor Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />