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*The free Adobe Reader may be 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 DWR Use Only—Do Not Fill In <br /> Page 38 of 42 Well Completion Report [ ��-��—T--f--� <br /> Rererto tnewdion Pamphiat <br /> Owner's Well Number EW-7A No. e0162853 State Well Number/Site Number <br /> Date Work Began 09/24/2012 Date Work Ended 10/1/201 _ -i—---L-- - N --L W <br /> Local Permit Agency $an Joaquin County Environmental Health D>,>�t Latitude Lon itude - <br /> Permit Number NA Permit Date APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation O° Vertical O Horizontal OAngle Specify <br /> Dolling Method Hollow Slem Au er Name <br /> Drilling Fluid Bentonite mud <br /> Depth from surface Description M.siling Address <br /> Feet to Feet Describe materiel, min size,color,etc Cl State_Zi <br /> ld <br /> 25 0 Pressure Grout Well Location <br /> Acciress 6437 West Banner Street <br /> Ct y Lodi County San Joaquin <br /> Latitude N Longitude <br /> Deo. Min Sec. DeG. MN. Sed <br /> Datum Decimal Lat. Decimal Long. <br /> AFN Book Page Parcel <br /> Tq Mnshi Ran a Section <br /> Location Sketch Activit <br /> Etketchmustbedrawnbyhandaflerformis ranted. ( New Well <br /> North <br /> O Modification/RepJa <br /> O Deepen <br /> O Other- <br /> 0 <br /> ther <br /> O Destroy <br /> o.eam Placid. �em <br /> area,'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> Ilwev.naeraeecabe distance mwell o-dm roade.bwldinra,lanae,. O Vapor Extraction <br /> Pa.11 and match.man.us.admddnei rare,iImseads, OQlher <br /> lease be¢curateand complete <br /> .ter 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 25 Feet Estimated Yield• (GPM) Test Type <br /> Total Depth of Completed Well 25 Feet Tesl Length (Hours) Total Drawdown_(Feet) <br /> 1.2211 not be re resentative of a well's longterm yield. <br /> Casio s Annular Material <br /> Depth from Borehole Wall Outside Screrin Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Typ, if Any Surface Fill Description <br /> Feat to Feat Inches Inches Inches Inches Feet to Feet <br /> Attachments Certification Statement <br /> ❑ Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑ Well Construction Diagram Name All Well Abandonment <br /> ❑ Geophysical Log(s) Person.Firth or corporation <br /> 9245 Beatty Drive Suite A Sacramento_ --- CA 95826 <br /> ❑SoIlM/ater Chemical Analyses Address - State zip <br /> 17 Other Site Mao Signed ;, 10/23/2012 848359 <br /> Altwh additional intomlattan it it exists. " C-57 Licensed Water Well Contrecor Date Signed C-57 License Number <br /> DWR Tae REV.12005 IF ADDITIONAL SPACE IS NEEDED,USE NEXTCONSECUTIVELY NUMBERED FORM <br />