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'The free Adobe Reader Maybe used to view and complete mi;to m lowever,software must be purchased to complete,save,and reuse a saved form. <br /> File Original with DWR State of California DWR Use Onl –Do Not Fill In <br /> Page 1 or 1 Abell Completion Report , I I , <br /> Refer to Inslnction Pamphlet State Well NumberlSlte Number <br /> Owner's Well Number MW-2 No. e0268260 _ L N I I I w <br /> Date Work Began 04/13/2015 Date Wink Bnlad 4 1J 7/201E Latkutle Lon nude <br /> Local Permit Agency San Joaauin County Environnlg,l,JQ.,Health Department <br /> APN/TRS/Other <br /> Permit Number Permit Date 3r9/I,5 _ <br /> Geologic Log Well Owner <br /> Orientation OVertical 0Horizontal C4nglr Specify__ Name <br /> Drilling Method Hollow Stem Auger C iillb g :1)id Bentonite rtod Mailing Address <br /> Depth from Surface Descri pone Cit State_�i <br /> Feet to Feet Describe material, rain :ir< color,etc <br /> 45 0 Drill opanninlip,and install Mo1_itc fill;I well Well Location <br /> Address 2154 EI Dorado St <br /> City Stockton County San Joaquin <br /> Latitude N Longitude <br /> '-- Dae. Min Sen Deo. It Sec. <br /> --"' Datum Dec.Lat. Dec.Long. <br /> -- APN Book Page Parcel <br /> -- <br /> Township _—Ranee Section <br /> -- Location Sketch Activity <br /> -- Sketch must W drawn o hand aha,to-is ranted. (D New Well <br /> —_ North 0 Modification/Repair <br /> 0 Deepen <br /> -- 0 Other <br /> ._—.. 0 Destroy <br /> oesoaa,ammakaa.artamann is <br /> .--.. urdn' E(Zi LOG <br /> —_.. Planned Uses <br /> -- 0 Water Supply <br /> []Domestic El Public <br /> v w❑ Irrigation ❑Industrial IECEWED- <br /> 3 <br /> 0 Cathodic Protection <br /> —.. 0 Dewatering <br /> 0 Heat Exchange <br /> -- ' 0 Injection <br /> (D Monitoring <br /> s- 0 Remediation <br /> .--.. 0 Sparging <br /> 0 Test Well <br /> --" South <br /> 0 Vapor Extraction <br /> —" aware o,nct`rZ auaca nea to mat..aupfmacemmin.l.n, 0 Other <br /> em.arta rate and u.e eOtironel oeom it nec.u.n. <br /> '--" vk a pa accurate am aaa W. <br /> -- Nater Level and Yield of Completed Well <br /> -- Depth to first water 22 _ (Feet below surface) <br /> --.. Depth to Static <br /> _ Water Level (Feet) Date Measured <br /> Total Depth of Boring 45 Feet Estimated Yield' (GPM) Test Type <br /> Test Length (Hours) Total Drawdown_(Fel <br /> Total Depth of Completed Well 45 Feel •Ma not be re resentative of a well's long term yield. <br /> Cali Annular Material <br /> Depth from Borehole Type Maleri II wen Outside Screen Slot Size Depth from <br /> Surfacefrom <br /> Diameter Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches __ Inches Inches Inches Feet to Feet <br /> 45 25 8 Screen PVC Sch.40 2 Milled Slots 0.020 45 23 Filter Pack #3 Sand <br /> 25 0 8 Blank PVC Sch.4o.__ 2 23 21 Bentonite chips <br /> 21 0 Cement Portland 1/11 <br /> Attachments __„ Certification Statement <br /> ❑ Geologic Log .,t to undersigned,certify that this report is complete and accurate fo the best of my knowledge and belief <br /> ❑Well Construction Diagram Vam All Well baAn rat Inc <br /> Person,Firm.x Corporetion 95742 <br /> ❑Geophysical Logs) _ f!; Fitzgerald RCad_SOL Ra bo Cordova CA <br /> Attl,e City Stets ZIP <br /> ❑ Soil/Water Chemical Analyses / 5/26/2015 848359 <br /> O Other c-sT ursnsa<I er w rector Date Signed., C-57 License Number <br /> Attach stational information ti it atists. �. <br /> pNR 189 REV.1r20D8 f i D[I�IONaI SPACE ISNEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />