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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 /> Page 1 of 1 Well Completion Report DWR Use Only—Do Not Fill In <br /> - - - <br /> Refer!01nSiruC60n Pam!-hie! � I I ' <br /> Owner's Well Number EW-1 NO- e0301561 __ State Well Numb it Number <br /> Date Work Began 01/13/2016 Date Work Ended 1/20/2016 _ I I I N- I -1 t __1._ �`/ <br /> Local Permit Agency San Joaquin Countv Environm ntal H alth D Dartm nr LatituTde Longitude__Li I I I I <br /> Permit Number SR0073506 Permit Date 10/27/15 —t—� <br /> APN/TRSlOther <br /> Geologic LogWell Owner <br /> Orientation OVertical 0Horizontal OAngle Specify <br /> Drilling Method Hollow Stem Au erName Swaran Chouhan <br /> Drilling Fluid Bentonite mud <br /> Depth from Surface Description Mailing Address 1632 Paola Place <br /> Feet to Feet Describe material,grain size,color,etc City Manteca State CA iD 95337 <br /> 66 0 Drilled out to total depth utilizing a truck mounted <br /> Well Location <br /> CME-75 with 15-inch hollow stem augers Address 701 East Charter Avenue <br /> - City Stockton County San Joaquin <br /> Latitude N Longitude W <br /> Deo Mln Sec Dea Min <br /> Sec <br /> Elatum Dec. Lat. Dec. Long. <br /> PPN Book 147 Page 343 Parcel 11 <br /> Township —Range Section <br /> Location Sketch Activitv <br /> Sketch must be drawn by hand after form is prmteo O New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> — <br /> 0 Destroy <br /> Describe procedures and materials <br /> under-GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> []Domestic ❑Public <br /> ' N <br /> m ❑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 /> O Sparging <br /> South O Test Well <br /> [pl.c <br /> lale or describe distance of well from roads.buildings.fences. O Vapor Extraction <br /> s,etc and aaac,d rnap Use addo—al paper f necessary O Other <br /> so be accurate and complete <br /> lete <br /> W,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 66 Feet Estimated Yield ' (GPM) Test Type <br /> Total Depth of Completed Well 66 Feet Test Length (Hours) Total Drawdown (Feet) <br /> 'May not be re resentative of a well's long term yield. <br /> Casio s Annular Material <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Type if Any Surface <br /> Feet to Feet InchesFill Description <br /> 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 Firm or Corporation <br /> 3369 Fitzgerald Road Rancho <br /> ❑ Soil/Water Chemical Analyses Address,�,:-�'�— City State <br /> CA 95742 <br /> slate z, <br /> D Other Site Mao Signed ,— " 2/22/2016 848359 p <br /> Attach additional information it it exists. C-57 tac$ ed Water Wen Coritrector Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 IF AD61TIONAL$PACE IS NEEDED.USE NEXT CONSECUTIVELY NUMBERED FORM <br />