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'The free Adobe Reader may be used to view and complois form. However,software must be purchased to complete,*and reuse a saved form. <br /> File Original with DWR State of California DWR Use Only—Do Not Fill In <br /> Well Completion Report l I <br /> Page 1 Of 1 Refer to Instruction Pamphlat State Well Number/Site Number <br /> Owner's Well Number SP-7A No. e0178556 <br /> Date Work Began 05/16/2013 Date Work Ended 5/16/2013 _ —1 Latitude 1— N Longitude I W <br /> Local Permit Agency San Joaauin County Environmental Health Department <br /> Permit Number 67140 Permit Date 5/10/13 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specify Name Donald Rogers <br /> Drilling Method Hollow Stem Auger Drilling Fluid none <br /> Mailing Address 11900 South Union Road <br /> Depth from Surface Description <br /> Feet to Feet Describe material,grain size,color,etc .2ty.2tManteca State Chi 95336 <br /> Well Location <br /> 0 45 The boring was drilled with 8-inch hollow stem Address 515 West Charter Way <br /> auger and sample at 5-foot intervals. C,ty Stockton County San Joaquin <br /> Latitude N Longitude _W <br /> The well materials described below were installed Deo. Min Sec. Dea. Min sec. <br /> into the boring. Datum Decimal Lat. Decimal Long. <br /> APN Book 14,7 Page 074 Parcel 08 <br /> The flush mount well box was installed with a Township —Range Section <br /> concrete apron. Location Sketch Activity <br /> 'Sketch must be drawn by hand after form is punted. Oi New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> O Destroy <br /> Describe procedures and materials <br /> under'G- GIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic []Public <br /> See Attached ; ❑Irrigation ❑Industrial <br /> w <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> 0 Sparging <br /> South O Test Well <br /> lllu!trate or describe distance of well from roads,buildings,fences, O Vapor Extraction <br /> ­rs,etcand attach a map.Use additional paper if necessary. O Other <br /> Pie ase be accurate and complete <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 45 Feet E;;timated Yield' (GPM) Test Type <br /> Test Length (Hours) Total Drawdown (Feet) <br /> Total Depth of Completed Well 45 Feet 'hlay not be representative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Type Material wall Outside Screen Slot Size Depth from <br /> Surface Diameter Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 45 43 8 screen PVC Sch.40 .218 2 Milled Slots 0.020 45 41 Filter Pack #3 Sand <br /> 43 0 8 Blank PVC Sch.40 .218 2 41 39 Bentonite Chips <br /> 39 1 Cement Portland 1/II <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, Inc. <br /> Person,Firm or Corporation <br /> O Geophysical Log(s) 9245 Beatty Drive Suite A 4accarn.ento CA 95826 <br /> ❑ Soil/Water Chemical Analyses Address � r��-',;_ ------City State zip <br /> � Other Site Map Signed ,-.�0 � .�~ 6/6/2013 848359 <br /> Attach additional information if it exists. C-57 Licensed Water Well Con raclor Date Signed C-57 License Number <br /> DWR 188 REV.112006 IF ADDITIONAL SPACE IS NEEDED,USE NI:XT CONSECUTIVELY NUMBERED FORM <br />