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'The free Adobe Reader may be used to view and complete this form. However,software mast be purchased to complete,Save,and reuse a saved form. <br /> File Original with DWR State of California DWR Use Only Do Not Fill In <br /> ,.--- <br /> Page 1 of 1 Well Completion Report <br /> Rerer to instruction PampMet I I I <br /> Owner's Well Number MW-7 State Well NumberlSite Number <br /> No. e0123740 { �-F - i-n L--�- 5V <br /> Date Work began 1212812010 Date Work Ended 12/28/2010 Latitude <br /> Local Permit Agency San JOaouin County Envir Lon itude <br /> Permit Number61677 - onme (}lealtn <br /> Permit Date 12/21110 APNlTRSlOther <br /> Geolo is Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name_Central California Traction Comoany <br /> Drilling Method Hollow Stem Au er Drilling Fluid <br /> Depth from Surface Description Mailing Address 2201 West Washington St <br /> Feet to Feet Describe material grain size color,etc City Stockton State CA ip 95203 <br /> Drill out casing backfill with neat cement to 0.5 feet I Well Location <br /> below rade;removed well box completed with dirt Address 1645 Cherokee Rd <br /> and gravel to surface. City Stockton County San Joaquin <br /> Latitude N Longitude �yy <br /> Deq. Min. Sec. —FWC—I Min Sec. <br /> Datum Decimal Lat. Decimal Long. <br /> APN Book Page Parcel <br /> Townshi Ran a Section <br /> Location Sketch Activ' <br /> Sketch mus;be drawn b hand after form is Tinted. O New Well <br /> North <br /> O Modification/Repair <br /> See S; a P/..n O Deepen <br /> O Other <br /> 0 Destroy <br /> Desmbe proctdures and matenals <br /> under•GEOLOGIC LOG' <br /> Planned Uses <br /> 0 Water Supply <br /> ❑Domestic ❑Public <br /> ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> 0 Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> Ittustrale or de¢cnbe diatonct of wcA kom roads,building¢,frncos, O Vapor Extraction <br /> riven,ek.and attach a may.Use addtiunal papa it nacnsary. O Other <br /> Pkaso be accurate end com leto. <br /> IW <br /> ater 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 67 Feet Estimated Yield• (GPM) Test Type <br /> Total Depth of Completed Welt 67 Feet Test Length (Hours) Total Drawdown (Feet) <br /> "Ma not be re resentative of a well's longterm 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 inches 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 /> ❑Welt Construction Diagram Name Gregg Drilling&Testing Inc. <br /> 1:1 Geophysical Log(s) Person,Finn or Corporation <br /> 950 Howe Rd. Martinez CA 94553 <br /> ❑ Soil/Water Chemical Analyses Address city Stale zip <br /> El Other Site Plan Signed} RAI- 419- 6 Zo4R D,,'l�a+lzuc�� J f jr� t I 485165 <br /> Anach additional information,if it ezizts. C-5/Licensed Water Well Contractovv .,J Date Signed C-57 License Number <br /> 0V%R 188 REV.1l2006 IF ADDITIONAL SPACE!S NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />