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'The free Adobe Reader maybe 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 <br /> DWR Use Only—Do Not Fill In <br /> Page 33 of 42 Well Completion Report <br /> Referto Instruction Pamph'el 1 <br /> Owner's Well Number EW-2 No. e0162848 State..."111.1n edSIW Number <br /> Dale Work Began 09/24/2012 Date Work Ended 10/1/2012 _ --I-- — L—.N I W <br /> Local Permit Agency San JOaOLIn County ' onm nt I health D Damne t Lelimda Lon itude <br /> Permit Number NA Permit Date <br /> APNRRS/Other <br /> Geologic LopWell Owner <br /> Orientation OVertical OHorizontal qSentonite <br /> y <br /> Drilling Method Hallow Stem Au erName <br /> Drilling Fluidnite mudDepth from Surface DescMailing Address <br /> Fcelto Feel Decribe e , t <br /> 25 0 Pressure Grout State �i <br /> Well Location <br /> Address S>437 West Banner Street <br /> City Lodi County San Joaquin <br /> Latitude NG M'n N Longitude _ _ N <br /> Sec. DaG. Min Sec. <br /> Dituni Decimal Let. Decimal Long. <br /> APN Book Page Parcel <br /> Townshi Ran a Section <br /> Location Sketch Activi <br /> Sketch must be dawn by hand after conn is rirtetl. Q New Well <br /> NorthQ Modification/Repair <br /> O Deepen <br /> O Other <br /> - <br /> 0 Destroy <br /> Order ce Po<edwas.od mm<na. <br /> unEer'GEOLOGIL LOG- <br /> Planned Uses <br /> Q Water Supply <br /> ❑Domestic ❑Public <br /> w EJ Irrigation El Industrial <br /> Q Cathodic Protection <br /> 0 Dewatering <br /> 0 Heat Exchange <br /> 0 Injection <br /> 0 Monitoring <br /> 0 Remediation <br /> Q Sparging <br /> South Q Test Well <br /> 1wm�r.p.da..neemsu.<e m.,en rvem,o.a.,buldires.urv<.., Q Vapor Extraction <br /> 'm.eu.andenacham.p.uea.dddoe.lpeeere.emesan. Q Other <br /> pbeuibeac nuand.. ler.. <br /> Water Level and Yield of Completed Well <br /> Del:in to first water <br /> Depth to Static (Feet below surface) <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 25 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 25 Feet Tes''.Length (Hours) Total Drawdown_(Feet) <br /> 'Ma not be re resentative of a well's Ion term field. <br /> Casings Annular Material <br /> DepthfromBorehole Wall Outside Screlln Slot Size 5e th from <br /> Surface Dlemeter ryPa Material Thickness Diameter Typrt If Any Surface Fill Description <br /> ffiFeetto Inches Inches Inches Inches Feet to Feet <br /> Attachments " Certification Statement <br /> ❑Geologic Log r <br /> ,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑ Well Construction Diagram bandonment <br /> ❑ Geophysical Log(s) Finn or Corporation <br /> rive Suite A Sacramento CA 95826 <br /> ❑Soil/Water Chemical AnalysesAddressem <br /> ❑O Other Site Mao -- � 3/2012 848359 Zip <br /> Adatlt additional Information if it exists. med Water Well Contrecrw Date Si ned C-57 License Number <br /> DNR 1B8 REV.72008 IF ADDITIONAL SPACE IS NEEDED.USE NEx1CONSECUTIVELY NUMBERED FORM <br />