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'The free Adobe Reader may be used to view and complete this form. However,software must bc: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 1 of 1 Well Completion ReportI - - T <br /> Refer to Instruction Pamrhlel I 1 t f I I I I I <br /> Owner's Well Number MW-2 No. e0301553 State Well Number/Site Number <br /> Date Work Began 01/13/2016 Date Work Ended 1/20/2016 I - N __ .._.l_ __t_ _W <br /> Local Permit Agency San Joaauin County noir — Latitude Lon itude <br /> 9 Y onmental H alth nem Department I - <br /> Permit Number SR0073506 _ Permit Date 10/27/15 APNlTRS/Other <br /> Geologic Lo Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specify <br /> Drilling Method Hollow Stem Auger Bentonite mud t4ame Swaran <br /> Drilling Fluid Chouhan <br /> 9 <br /> Depth from Surface Description Mailing Address 1632 Paola Place <br /> Feet to Feet Describe material grain size,color,etc (,ity Manteca State_C_A___zip 95337 <br /> 49 0 Drilled out to total depth utilizing a truck mounted Well Location <br /> CME-75 with 8-inch hollow stem augers Address 701 East Charter Avenue <br /> City Stockton County_San Joaquin <br /> Latitude N Longitude <br /> Deo Min Sec. Deb Min SeV <br /> Ctatum Dec.Lat. Dec.Long. <br /> APN Book 147 Page 343 Parcel 11 <br /> Township -Range Section <br /> Location Sketch Activity <br /> -- Sketch must be drawn by hand after form is printec 7:5 New Well <br /> North O Modification/Repair <br /> O Deepen <br /> - -- O Other <br /> Destroy <br /> Desaibe procedures antl maleriak <br /> under'GEOLOG'c LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> LU ❑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 /> Illustrate or describe distance of wall from roads.buildings.fences O Vapor Extraction <br /> nye ,etc and attach a map Use additional paper d necessary O Other <br /> PI-se be accurate and complete <br /> ater Level and Yield of Com leted 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 Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 49 Feet Test Length (Hours) Total Drawdown (Feed <br /> 'Ma not be re resentative of a well's Ion 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 Description <br /> Feet to Feet nches 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 Fitz erald Road �' Rancho Corova CA 95742 <br /> ❑ Soil/Water Chemical Analyses Add' sS' "`—' <br /> City Slate Zip <br /> O Other Site Map Signed 2/22/2016 848359 <br /> Attach additional information if it ewsts. C-57 ehsed W Vell Contractor Date Signed C-57 License Number <br /> DWR 188 REV 1/2008 IF ADDITIONAL SPACE NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />