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'The free Adobe Reader may be used to view and complete IN 4 fo'm iowever,software must be purchased to complete,save,and reuse a saved fort. <br /> File Original with DWR State of California DM Use Only–Do Not F&In <br /> 011 ll Completion Report I I I <br /> Page 1 of 1 Refer to tdsta cion Pamphlet State Well Number/She Number <br /> Owner's Well Number MW-22 No. e0269483 l N I <br /> Date Work Began 02/10/2015 Date Wnrk Erded 2/19/2015 Latitude Lon nude <br /> Local Permit Agency San Joaau'n County EnVTonn)i;j1JWj ,-lealth Department <br /> Permit Number 71470 Permit Date APNrtRS/Othat. <br /> 2i <br /> Geologic Log _ Well Owner <br /> Orientation OVertical 0Horizontal C.4nglr specay__ Name City of Stockton <br /> Drilling Method Hollow Stem Auger Ciilla g ' rid Bentonite and Mailing Address 345 North EI Dorado St <br /> Depth from Surface DeSofl;rtllrn Cil Stockton State chi 95205 <br /> Feet m Feet Describe material r iin oo r color,etc <br /> 55 10 Drill Sam le and install well u:irl; 8"Hallow Well Location <br /> Stem auger see below for wei, r i aterials Address 2050 Freemont St <br /> --.. City Stockton County San Joaquin <br /> --_ Latitude N Longitude __yy <br /> Dim Min. Sec. b—Ewa—aa. Min. Sec <br /> -- Datum Dec.Lat. 37.98213 Dec.Long.-121.2650 <br /> -- APN Book Page Parcel <br /> -- <br /> Township Range Section <br /> Location Sketch I Activi <br /> — Sketch must De drawn by hand after form is printed. Q New Well <br /> --., North O Modification/Repair <br /> _ O Deepen <br /> O Other <br /> -- O Destroy <br /> cesoihe w«dead.au maal.l. <br /> --" un«�GEOLOGIC LOG' <br /> -- Planned Uses <br /> — O Water Supply <br /> --.. ❑Domestic ❑Public <br /> []Irrigation []Industrial <br /> 3 <br /> --„ O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> --- O Injection <br /> --" (D Monitoring <br /> --- O Remediation <br /> .--.. O Sparging <br /> O Test Well <br /> —" South O Vapor Extraction <br /> --" Illustrate w eescrbe distance olwell Rwn roarfe,Whirr,.lenwe. <br /> a..ammeeh.irae uee.edaiwel Peru it Pece"rerr. Q Other <br /> —" vl....Ire tae ane."m wt.. <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 field. <br /> s Annular Material <br /> Casin <br /> L.—.. <br /> Depth from BoreholeMalerlrtl well Outside Screen Slot Size Depth from F111 Description <br /> Surface Diameter Thickness Diameter Type Inches Fe Sueet rf Feet <br /> TyAny pe <br /> Feet to Feel Inches -- Inches Inches <br /> — 2 Milled Slots 0.020 55 38 Filter Pack pe sand <br /> 55 40 8 Screen PVC Sch.4o 3 <br /> 40 0 8 Blank PVC Sch.40 _ 2 0.020 6 36 Bentonite pellets <br /> 36 1 cement Portland Illl <br /> -- 1 0 Cement seal <br /> Attachments Certification Statement <br /> ❑Geologic Log I,the a idersigrhed,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram IJa nr All Well Abandonment Inc <br /> g Person F'Irm nr Corporation <br /> ❑ Geophysical Log($) 2 E!; Fitzgerald rd sui er6-.'� Rancho Cor,T dDva CA <br /> 95742 Zip <br /> ❑Soit Water Chemical Analyses Atl°r",'%' City 6/2/2015 848359 <br /> O Other site map 3i{of n �'� <br /> csr uaero«I rx ugaM or � Date Si red C-57 License Number <br /> Arson additional iMotmelim a Il adsts. <br /> DWR 788 REV.180M F IDC I IIONgL SPACE IS NEEDED.USE NEXT CONSECUTIVELY NUMBERED FORM <br />