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-The free Adobe Reader maybe used to view and complete th n h m However,software must be purchased to complete,save,and reuse a saved form. <br /> File Original with DWR Stale of California DWR Use Only-Do Not FM In <br /> Vi all Completion Report <br /> Page 1 of 1 Refer to Inafrotflon Pamphlet State Well Number/Site Number <br /> Owner's Well Number IW-5 No. e0269497 �W <br /> Date Work Began 02/10/2015 Date Work Eicled 2/19/201!5 Latitude Lon kude <br /> Local Permit Agency San Joaouin County Environr(lalU,.Health Department <br /> Permit Number 71470 Permit Date 23,.15 APN/rRS/Other <br /> Geologic Log Well Owner <br /> Orientation O` Vertical O Horizontal 0A gl,. Specify__ Name CitV Of Stockton <br /> Drilling Method Hollow Stem Auger Will,ig Iuid Bentonite nud Mailing Address 345 North El Dorado St <br /> Depth from Surface Descr 3ti3n Stockton ca 95205 <br /> Feet to Feet Describe material, vin ser color,etc Cit on State_-Zi <br /> 120 0 Drill Sample and install wEll Lsi 1118"Hollow Well Location <br /> Stem auger see below for well INaterials Address 2050 Freemont St <br /> .__.. City Stockton County San Joaquin <br /> ,__.. Latitude N Longitude ___ _W <br /> Dec. Min. Sec. Dee. Min. Sec <br /> -- Datum Dec.Lat. 37.98213 Dec.Long.-121.2650 <br /> -- APN Book Page Parcel <br /> Township -Range Section <br /> Location Sketch Activity <br /> —" Sketch must be dra_xn by hand after form is printed. O New Well <br /> -- Noon O Modification/Repair <br /> .--_, O Deepen <br /> O Other <br /> -- O Destroy <br /> --" under GEOLOGIC LOG' <br /> --' Planned Uses <br /> --' O Water Supply <br /> .--. ❑Domestic ❑Public <br /> ❑Irrigation ❑Industrial <br /> --.. O Cathodic Protection <br /> .--.. O Dewatenng <br /> OHeat Exchange <br /> (D Injection <br /> O Monitoring <br /> --" O Remediation <br /> -- O Sparging <br /> .--.. O Test Well <br /> South <br /> '--" nlu.o-.Nwd.+glee a+uan"f wen nem ra.a.wlwms..seep+. O Vapor Extraction <br /> .en,andadau,.mao. u+e.eauonapea«unere+a.rr OOther <br /> —" r�eass e.accurate and aom We <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 120Feet Estimated Yield' (GPM) Test Type <br /> Test Length (Hours) Total Drawdown_(Feet) <br /> Total Depth of Completed Well 120 .--.._ Feet -May not be re resentative of a well's long term yield. <br /> Cosi g_., Annular Material <br /> Depth from Borehole Wall Outside Screen Slot size Depth from <br /> Surface Diameter Type Mater nl Thickness Diameter Type if Any Surface Fill Description <br /> r <br /> o Feet Intoes __ Inches Inches Inches Feel m Feet <br /> Wscreen PVC Sch.40 2 Milled Slots 0.020 120 98 Filter Pack #3 SanBlank PVC Sch.40 2 0.020 98 96 Bentonite pellets <br /> '-- 96 1 Cement Portland 1/II <br /> -- 1 0 Cement seal <br /> Attachments Certification Statement <br /> ❑ Geologic Log ;-E .Indersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram NI m: All Well Abandonment Inc <br /> Person.Firth or Corporation <br /> ❑Geophysical Log(s) 31 ill Fitzgerald of suite Rancho Cordova CA 95742 <br /> ❑ SoIVWater Chemical Analyses Adore j city slate zip <br /> O Other site map Si 7n sd 6/2/2015 848359 <br /> Atte r,addlllo,,roormatlon It 11 easts �— 7 Lac-nwidwatN' er Date Signed C-57 License Number <br /> OM Ira REV.12906 IF tD; rIONAL SPACE IS NEEDED.USE NEXT CONSECUTIVELY NUMBERED FORM <br />