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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 /> DWR Use Only-Do Not Fill In <br /> Page 1Df 1 Well Completion Report T T <br /> Refer!o!nsrruohon PamFh!ef I I I <br /> Owner's Well Number VW-2 No. e0301558 State Well Number/Site Number <br /> Date Work Began 01/13/2016 Date Work Ended 1/20/2016 _ -' I I--- N _I _L._-.__1_ .._1_- _W <br /> Local Permit Agency San Joaouin Countv Environmental Health Department L Lat 1 Longitude <br /> Permit Number SR0073506I I I I I <br /> Permit Date 10/27/15 APN/TRS/Other <br /> Geologic Lo Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specify <br /> Drilling Method Hollow Stem Auger Name Swaran Chouhan <br /> Drilling Fluid Bentonite mud <br /> Depth from Surface Description Mailing Address 1632 Paola Place <br /> Feet to Feet Describe material, rain size,color,etc Cit Manteca State CA �i 95337 <br /> 36 0 Drilled out to total depth utilizing a truck mounted <br /> Well Location <br /> CME-75 with 8-inch hollow stem augers F,ddress 701 East Charter Avenue <br /> City Stockton County San Joaquin <br /> Latitude N Longitude <br /> -Deo Min Sec. Dee Min Sec W <br /> Datum Dec Lat. Dec.Long. <br /> APN Book 147 _ Page 343 Parcel 11 <br /> Townshi Range Section <br /> Location Sketch Activity <br /> Sketch must be drawn by hand after form is printed i Q New Well <br /> North <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 /> Q Water Supply <br /> —_ ❑Domestic ❑Public <br /> w <br /> []irrigation ❑Industrial <br /> Q Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> Q Injection <br /> O Monitoring <br /> Q Remediation <br /> O Sparging <br /> South Q Test Well <br /> Illustrate a(11110,distance of well from roads.bwdmgs lenses Q Vapor Extraction <br /> ---- -_—_—. ;.etc and attach a map use aftt,onal PaPer it necessary Q Other <br /> Please 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 36 Feet Estimated Yield` (GPM) Test Type <br /> Total Depth of Completed Well 36 Feet Test 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 Any Surface Fill <br /> Feet to Feet Inches Inches Inches Description <br /> LEInches Feet to Feet <br /> Attachments ICertification 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 Fitz eralddRoatt—'9' R ncho Corova CA 95742 <br /> ID Other Site Map Signed �- City State Zip <br /> 2/22/2016 848359 <br /> Attach additional Information if it exists _ C• ater Well Coaor <br /> DWR 188 REV 1/2006 Date Signed C-57 License Number <br /> ;F ADDITIOW<SPACE IS NEEDED.USE NEX"r CONSECUTIVELY NUMBERED FORM <br />