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'The free Adobe Reader may be used to view and complete Itis h,m However,software must be purchased to complete,save,and reuse a saved forth. <br /> File Original with DWR State of California DWR Use Only—Do Not FYI In <br /> Page 1 of 1 Well Completion Report F -- <br /> Rehv to I9stwoon Pamphlet State Well Number/She Number <br /> Owner's Well Number MW-24 No. e0269489 1 I N I y'y <br /> Date Work Began02/10/2015 Date Nork E,ded 2/19/201.5 Latitude Lon itude <br /> Local Permit Agency San Joaauin County Environipglvl.Health Department <br /> Permit Number 71467 Permit Date 213.15— APN/rRS/Other <br /> Geologic Lo Well Owner <br /> Orientation OVertical 0Horizontal (:Ai gl[ Specify__ Name City Of Stockton <br /> Drilling Method Hollow Stem Auger I:rill ng fluid Bentonite rnud <br /> Depth from Surface Descriptlor Mailing Address 345 North EI Dorado St <br /> Feet to Feet Describe material sin sun color,ek Cil Stockton State Ca �i 95205 <br /> 55 10 Drill Sample and install WE.] L Si' 3 8"Hollow Well Location <br /> Stem auger see below for wE 11 I:aterials Address 2050 Freemont St <br /> .--.. City Stockton County San Joaquin <br /> .--.. Latitude N Longitude __--_—N <br /> Dec. Min. Seo. Dec. Min. Sec <br /> -- Datum Dec.Lat. 37.96202 Dec.Long.-121.26496 <br /> APN Book Page Parcel <br /> Township —Range Section <br /> Location Sketch Adpi <br /> -- sketch must ce dmvn b hand after form is 'nted. O. New Well <br /> ---.. North O Modification/Repair <br /> --„ ()Deepen <br /> O Other <br /> -- Q Destroy <br /> under a aad.e.ree ee meu ae <br /> '--" .ma�soLocac roc <br /> --" Planned Uses <br /> --" O Water Supply <br /> — <br /> []Domestic ❑Public <br /> ❑Irrigation []Industrial <br /> -- O Cathodic Protection <br /> .--.. O Dewatering <br /> ---. O Heal Exchange <br /> (7 Injection <br /> l7 Monitoring <br /> —' O Remediation <br /> ---- — O Sparging <br /> South O Test Well <br /> .--.. eyeless Mde.Na.aeraace or xeaa eom <br /> -' madeemnme•.anus, O Vapor <br /> Extraction <br /> keic andanah.madOther <br /> c,:e <br /> a.r.. <br /> -- ' Nater 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 *Ma not be re resentative of a well's Ion term ield. <br /> Casi:gt Annular Material <br /> Depth from Borehole Type Materal wall Outside Screen Slot Size Depth from <br /> y <br /> Surface Diameter Thickness Diameter Type If Any Surface Fill Description <br /> Feet to Feet Inches __ Inches Inches Inches Feet to Feet <br /> 55 40 8 screen pve <br /> ch.40 "_FMilled Slots 0.020 55 38 Filter Pack #3sand <br /> 8 Blank PVC Sch.4p 0.020 38 36 Bentonite pellets <br /> -- 36 1 cement Portland 1/11 <br /> ”— 1 D Cement seal <br /> Attachments Certification Statement <br /> ❑ Geologic Log I,'ha undersl ned,erartify that this report is complete and accurate to the best of my knowledge and belief <br /> C3Well Construction Diagram N;ni All Well Abandonment Inc <br /> Person,Firm Or Corpora8« <br /> ❑ Geophysical Log(s) _ ;!)Fitzgerald rd suite 8 %f Rancho Co ova CA 95742 <br /> 7 _ ci sWta zip <br /> ❑ SoilfWater Chemical Analyses Add ,i b <br /> ❑+ Other Site TIED y Siantl "' 6/2/2015 848359 <br /> A lain additional Infodoauon a it exists. _� c-sT u e « «« Date Signed C-57 License Number <br /> own 188 REV.1¢006 IF>D:I DONAL ACE IS NEE ED.USE NEXT CONSECUTIVELY NUMBERED FORM <br />