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'The free Adobe Reader maybe used to view and complete it is him 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 Fit In <br /> Page 1 of 1 III CompNeRefer to tionPamphlet <br /> I I I I <br /> Owner's Well Number MW-23 No. e0269488 State Well Number/Site Number <br /> : I <br /> Date Work Began 02/10/2015 Date W orh E,Iletl z/1s/zo1i Latitude I Wr <br /> Lon nude <br /> Loral Permit Agency.San Joaauin County Env rant jIgIt 1,Health Deoa rtment <br /> Permit Number 71467 Permit Date 213.1$ APN?RS/Other <br /> Geologic Log Well Owner <br /> Orientation OVertical 0Horizontal (1Aug1[ Specify__ Name City Of Stockton <br /> Drilling Method Hollow Stem Auger Crill ng 19uid Bentonite rnud Mailing Address 345 North E Dorado St <br /> Depth from Surface Descriiin or Stockton Ca 95205 <br /> Feet to Feet Describe material, :rin so a color,etc Cit State_Zi <br /> 55 0 Drill Sample and install well Lsi'q 8"Hollow Well Location <br /> Stem auger see below for WEII raterials Address 2050 Freemont St <br /> --_, City Stockton County San Joaquin <br /> ._—.. Latitude N Longitude ______Vv <br /> Deq. Min. Sec. Deq. Min. sec. <br /> — Datum Dec.Lat. 37.96202 Dec. Long.-121.26496 <br /> ' APN Book Page Parcel <br /> ' <br /> Township —Range Section <br /> Location SketchLNew <br /> ivi <br /> '--" Sketch must be drawn t nand after form is riled.North ion/RepairnC<Alrlr.M meloglc ioc <br /> _ Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> w ❑Irrigation ❑Industrial <br /> E -• O Cathodic Protection <br /> .—�—.. O Dewatering <br /> P AL 'erneT O Heat Exchange <br /> VI E — O Injection <br /> 0 Monitoring <br /> -" O Remediation <br /> '--- O Sparging <br /> South O Test Well <br /> —" nlmb.le a desaee ananv,olid)aom meas,eammas.kooes. OVaDor Extraction <br /> a�.ann enecnemep.use aaauo.ei moo�aoeas:aw OOthef <br /> '--" Gkase Ee accurate a.tl cdn kle. <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 55 _ Feet Estimated Yield* (GPM) Test Type <br /> Test Length (Hours) Total Drawdown_(Feet) <br /> Total Depth of Completed Well 55 Feet *Me not be,re resentative of a well's Ion term teld. <br /> ti_., Annular Material <br /> Depth from BoreholeWall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Matsrl 11 Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches __ Inches Inches Inches Feet m Feet <br /> 55 40 $ Screen PVC Son.40 _ 2 Milled Slots 0.020 55 3$ Filler Pack 73 sand <br /> 40 0 8 Blank PVC Son.40 2 0.020 38 36 Bentonite pellets <br /> -- 36 1 Cement Portland I/II <br /> -- 1 0 Cement seal <br /> Attachments Certification Statement <br /> ❑Geologic Log t to lindersignetl,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Nami� All Well Aba'ldonment Inc <br /> Person,Firm IN CerperauPr <br /> ❑ Geophysical logs) 23f;' Fitzgerald rdsuite.8' - 5fich .Cordova CA 95742 <br /> A4b�fsa. ..�~ City Stele zip <br /> ❑ Soil/Water Chemical Analyses &J!! /j.. ;,� 6/2/2015 848359 <br /> O Other site map SIf"'' <br /> Atterll addib.W iMgrtnabon a it evsts. 771;'- <br /> -45]Ucensetl water NEII eu« Date Si ned C-57 License Number <br /> DWR 188 REV.12008 ZONAL SPACE IS NEEDED.USE NEXT CONSECUrIVELV NUMBERED FORM <br />