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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 <br /> Well Completion Report DWR Use ------ o Not Fill In <br /> Page 1 of 1 ----- -- --_-------- <br /> Owner's <br /> Refer to Instruction Pamg hlef 1 I I F I I I I I l l <br /> Owner's Well Number MW-7 No. e0301555 --�_ State Well Number/Sde Number <br /> Date Work Began 01/13/2016 Date Work Ended 1/20/2016 _ I �----t- N -.L_L __L_ L._W <br /> Local Permit Agency San JOaguin COunty Fnyirnne..�r,rnl Health m nt -- Latitude Lon itude <br /> Permit Number_SR0073506 Permit Date 10/27/15 _=_1 I II I <br /> APN/TRS/Other <br /> Geolo is Lo <br /> Orientation O Vertical O HorizontalOAWell Owner <br /> Drilling Method Hollow Stem Auger Drillinging Specify Fluid Bentonite mud Name Swaran Chouhan <br /> Depth from Surface Description Mailing Address 1632 Paola Place <br /> Feet to Feet Describe material,grain size,color,etc (,Ity Manteca <br /> 49 0Drilled out to total depth Utilizinga truck mounted State CA �i 95337 <br /> CME-75 with 8-inch hollow Stem augers Well Location <br /> Address 701 East Charter Avenue <br /> City Stockton County San Joaquin <br /> Latitude N Longitude N <br /> Dea Min Sec. Dea. Min Sec <br /> Clatum Dec Lat. Dec.Long. <br /> APN Book 147 Page 343 Parcel 11 <br /> Townshl Range Section <br /> Location Sketch Activitif <br /> Sketch must be drawn b hand after form is anted <br /> North O New Well <br /> Q Modification/Repair <br /> O Deepen <br /> O Other <br /> Destroy <br /> Describe procedures and materials <br /> under-GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> ' m <br /> W []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 /> Illusuale or describe dstance of well from roads,buildings.lences, O Vapor Extraction <br /> river;,etc and attach a map Use additional paper if necessary Q Other <br /> Please be accurate antl com late <br /> Iter 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 49 Feet Es:imated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 49 Feet Te:5t Length (Hours) Total Drawdown (Feet) <br /> M 3y not be re resentative of a well's long term yield <br /> Casings Annular Material <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Type if An <br /> Feet to Feet Inches Inches Inches y Surface Fill Description <br /> 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.Firm or Corporation <br /> ❑ Soil/Water Chemical Analyses 3369 Fitzgerald Road �� Sancho Cocev�" ' CA 95742 <br /> y Address � �' CII Zip <br /> Other Site MaD Signed �-- City <br /> 848359 <br /> Attach additional Information it it exists. C57 Licensed� ractor <br /> DWR 188 REV.1/2006 Date Signed C-57 License Number <br /> IF ADDITIONAL SPACE IS NEEDED.USE NEXT CONSECUTIVELY NUMBERED FORM <br />