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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 /> - I <br /> Refer to Insiruclion pamphlet I I I I I <br /> Owner's Well Number EW-2 No. e0301562 State Well Number/Site Number <br /> Date Work Began 01/13/2016 Date Work Ended 1/20/2016 t I__ .N- LL 1 -_...L_.. -.1_ !N <br /> Local Permit Agency San Joaquin ni In — Latitude Longitude <br /> 9 Y tv Environm ntal H alth De^��tment �I I T <br /> Permit Number SR0073506 Permit Date 10/27/15 APN/TRSIOtner <br /> Geolo is Lo Well Owner <br /> Orientation O Vertical O Horizontal 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, rain size,color,etc Cit Manteca State CA—zip95337 <br /> 66 0 Drilled out to total depth utilizing a track mounted <br /> limited access drillingrig equipped Well Location <br /> 9 q Peed with 15-inch F,ddress 701 East Charter Avenue <br /> hollow stem augers City Stockton <br /> County_San Joaquin <br /> Latitude N Longitude VV <br /> Deo Mln Sec. DeMi <br /> q n Sec <br /> Datum Dec.Lat. Dec. Long. <br /> APN Book 147 Page 343 Parcel 11 <br /> Tpwnshi Ran a Section <br /> Location Sketch Activity <br /> (Sketch must be drawn by hand after form fs printea <br /> North O New Well <br /> Q Modification/Repair <br /> O Deepen <br /> O Other <br /> Destroy <br /> Describe procedures and mew,als <br /> under'GEDLOGc LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> Of ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> Q Dewatering <br /> O Heat Exchange <br /> O Injection <br /> Q Monitoring <br /> O Remediation <br /> O Sparging <br /> South Q Test Well <br /> musfale or describe distance of well from roads.bmldmgs fences. O Vapor Extraction <br /> �rve etc.and anach a map Use add,lional paper f 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 /> Wzter 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 /> Casings <br /> LLMay not be re resentative of a well's long term yield. <br /> 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 YP Y Surface Fill Description <br /> Inches Inches Inches Feet to Feet <br /> LL <br /> Attachments Certification Statement <br /> 0 Geologic Log I, the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> 0 Well Construction Diagram Name All Well Abandonment <br /> 0 Geophysical Log(s) Person.Firm or Corporation <br /> 0 Soil/Water Chemical Analyses L1369tz eralddRosad O Corova CA 95742 <br /> 0 Other Site Mal) T' COY Ftate <br /> Attach additional Information if it exists. G57 Lice writ2/22/2016 848359 <br /> er ontrartor <br /> DWR 188 REV 112006 Date Si ned C-57 License Number <br /> IF.ADDITIONAL SPA6E IS NEEDED.USE NEX'-CONSECUTIVELY NUMBERED FORM <br />