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-The free Adobe Reader maybe used to view and complete this Ion I. I,owever,software must be purchased to complete,save,and reuse a saved form. <br /> File Original with DWR Stale of California DWR Use Only–De Not rat In <br /> lW11 Completion Report I--- - T <br /> Page 1 of 1 Refer to instruction Fanai Stet.well Number/Sde Number <br /> Owner's Well Number MW-3 No. e0263270 I Latitude nude <br /> IN I I 1 'A' <br /> Date Work Began 04/1312015 Date Wo <Ent a 411712015— <br /> Lon <br /> Local Permit Agency San i^=^ 'n C n ntv Environm;na)I;lealth Department gpNRRstaher <br /> Permit Number Permit Date M!/1 _ <br /> Geologic Log <br /> Well Owner <br /> Orientation @Vertical @Horizontal 01.nl Is Specity_,_- E <br /> e <br /> rilling Method Hollow Stem Au er Dii lin g F:id Bentonile mudng Address <br /> Depth from Surface Descrif filen State._�i <br /> Feet to Fast Describe material, minaze -nlor etc Well Location <br /> 45 0 Drill sem le and install Morito'ini well <br /> Address 2154 EI Dorado St <br /> City Stockton County San Joaquin <br /> Latitude N Longitude __��rt' <br /> --" pap. Min. Sec. Dep Min. Sac. <br /> -- ' Datum Dec.Lat. Dec. Long. <br /> '-- APN Book Page Parcel <br /> Township Rancle Section <br /> --"' Location Sketch Activi <br /> .--- Sketch must ce drawnb hand after form is rimed. Q. New Well <br /> North O Modification/Repair <br /> --' O Deepen <br /> -- O Other- <br /> 0 <br /> ther <br /> O Destroy <br /> ceaaaa w«calm and mmeLls <br /> UM F GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> w ❑Irrigation ❑Industrial <br /> _ O Cathodic Protection <br /> O Dewatering <br /> --" O Heat Exchange <br /> --- O Injection <br /> -- @ Monitoring <br /> O Remediation <br /> --_, O Sparging <br /> O Test Well <br /> South O Vapor Extraction <br /> -- mutael<o<cetuae man=e of xell aom meads,eudmnse.fenua. <br /> :.n=..nd amrn.mao. um aealanal�a�enmmmry O Other <br /> .-- riasa.ba.=mx.ane pan w. <br /> -- ater Level and Yield of Com feted Well <br /> -- Depth to first water 22 (Feet below surface) <br /> --., Depth to Static Feet Date Measured <br /> Water Level (Feet) <br /> Total Depth of Boring 45 _—•,_ Feet Estimated Yield (GPM) Test Type <br /> Test Length (Hours) Total Drawdown_(Feet) <br /> Total Depth of Completed Well 45 .--..— Feet -Ma not be re -1 <br /> Depth <br /> of a well's Ion term field. <br /> -- Annular Material <br /> Caski _., <br /> Wall Outside Screen Slot Size Depth from Description <br /> Depth from Borehole <br /> Type Material Thlcknesa Diameter Type If Any Surface Fill P <br /> Surface Diameter Inches Itches Inches Feet to Feel <br /> Feet to Feet Inches -- 2 Milled Slots 0.020 45 23 Filter Pack #3 Sand <br /> 45 25 8 screen PV c sch.40 _ 23 21 Benton to chips <br /> 25 0 8 Blank PVC Sch.40— 2 21 0 Cement Portland)/II <br /> _ ., Certificati <br /> Attachments on Statement <br /> ❑ Geologic Log I, hr Nndersigned,cl;rtify that this report is complete and accurate to the best of my knowledge and belief <br /> C3 Well Construction Diagram Nemo All Well Abandonment Inc <br /> Person,firm or Corporation Ran hnpOrdoya CA 95742 Zip <br /> ❑ Geophysical Log(s) ;53;,3 Fitzgerald Ftoa . As B Cit, state <br /> ❑ Somater Chemical Analyses npara 5/26/2015 848359 <br /> 0 Other S gr�.i csr ucansrld coat .werenor Date Si netl C-57 License Number <br /> Attach sooners lofoamatim if ilexlss. <br /> DWR 188 REV.12006 IF AC:t TIONAL SPACE IS EEDED.USE NEXT CONSECtrrIVELV NUMBERED fORM <br />