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use a <br /> 'The free Adobe Reader maybe used to View and complete this torr t. IUwever,software must be purchased to complete,save,and reDWR Used form Do Not FIR In <br /> File Original with Di State of California <br /> WAI Completion Report <br /> Page 1 Of 1 Refer lO Instruction Pamphlet �State Well Number/She Number <br /> No. e0268273 I w <br /> Owner's Well Number MW-5 Lon itude <br /> Date Work Began 04/13/2015 Date Wo'<E nc ad 4/1712015— <br /> Tient <br /> Local Permit Agency S"" lona Cn mty Fri ronm,nJa,Health Deoartlr�^f gpNlTRS/Other <br /> Permit Number Permit Date ,3A/1!i - <br /> --•' Well Owner <br /> Geologic Lor' <br /> Orientation OVenical 0Horizontal Or'n�le Specify__ Name <br /> Dnlling McNOd Hallow Stem Auger Dr Ilim F u d Bentonite mud Mailing Address <br /> Depth from Surface Descripiaot Cit StateZi <br /> Feel to Feet Describe material rensza-:olor etc Well Location <br /> 45 0 Drill sem le and install Mor lin- well <br /> Address 2154 EI Dorado St - <br /> __ City Stockton County San Joaquin <br /> Latitude N Longitude —6;;-- <br /> --" Dee Min. Sec. Dae Min. Sec. <br /> '-- Datum Dec.Lat. Dec.Long. <br /> --" APN Book Page Parcel <br /> -- Townshi Ran a Section <br /> --" Location SketchMPIannedUses <br /> ctivi <br /> --- Sketch must be drawn b hand after umell <br /> Northation/Repair <br /> — pen <br /> --" er <br /> y <br /> I reavn and mm«roI. <br /> --„ OLOGIC LOG• <br /> —_.. ned Uses <br /> ._—... O Water Supply <br /> _— ❑Domestic ❑Public <br /> w ❑Imgation ❑Industrial <br /> Cathodic Protection <br /> O Dewatering <br /> Heat Exchange <br /> '---- O Injection <br /> -- (D Monitoring <br /> --.. O Remediation <br /> --., O Sparging <br /> O Test Well <br /> '--" South Q Vapor Extraction <br /> —" Inmvaie o.eeeao.mtance ot.an nam rwe..emNmw.tensa <br /> vw , <br /> mm..aand aaam a enev.ue.amepnal paper if n.a.eew- O Other. <br /> - ea aeaaum.ane.am bre. <br /> -- <br /> Rater 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 (Feet) <br /> Total Depth of Completed Well 45 .--.._ Feet 'Me not be re resentative of a well's Ion termoeld. <br /> , <br /> Annular Material <br /> Casings_. <br /> Depth from Borehole Materl:tl wall Outside Screen Slot Size Depth from Fill Description <br /> Surface Diameter Type Thickness Diameter Type If Any Surface <br /> Inches In^hes Inches Feet 10 Feel <br /> Feet to Feet Inches -- 2 Milled Slots 0.020 45 23 Filter Pack #3 Sand <br /> 45 25 8 Screen PVC Sch.40 --_ 23 21 Bentonite chips <br /> 25 0 8 Blank PVC Bch.a0 _— 2 21 0 Cement Portland 1/II <br /> Attachments Certification Statement <br /> ❑Geologic Log I,t Te nderslgned,certify that this report is complete ani,accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Nem: A1124 Abandonm nt In <br /> voeral im,20,151 uon RanchoRanoho'C — ,a 95742 Zrp <br /> ❑ Geophysical Log(s) 3b I Ftzeerald R.. t City <br /> stela <br /> atl°' 5/26/2015 848359 <br /> ❑ SoiWJater Chemical Analyses <br /> Si7n i, <br /> ❑+ Other nnI_ 57 cdwmer)9ms Date Signed C-57 License Number <br /> Attach additional iMoahon 0 it ad is <br /> IF. 1D-:.rIONAC SPACE IS NEEDED,USE NE%T CANSECUTIVELY NUMBERED FORM <br /> DWR 188 REV12006 <br />