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"rhe free Adobe Reader may be used to view and complete this form. However,software must 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 /> Page 1 of 1 Well Completion Report <br /> l <br /> Refer to Instruction Pamphlet <br /> Owner's Well Number Stockton 53-01 No. e0338845 State Well Number/Site Number�� <br /> Date Work Began 10/03/2016 N I I I W <br /> 9 Date Work Ended 3/30/2017 Latitude Longitude <br /> Local Permit Agency San Joaa_uin County Environmental Health D Dartment I II I I I I I I I <br /> Permit Number SR0076757 Permit Date 2/9/17 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name California Water Service Company <br /> Drilling Method Drilling Fluid <br /> Depth from Surface Description Mailing Address 1720 North First Street <br /> Feet to Feet Describe material,grain size,color,etc City San Jose State_CA___Zip 95112 <br /> 5 550 10.3 Sack Mix Well Location <br /> 30 550 Blast Perforated Well Address 413 North Aurora Street <br /> City Stockton County San Joaquin <br /> Latitude N Longitude w <br /> Deq. Min. Sec. Deq Min Sec <br /> Datum Dec.Lat. Dec.Long. <br /> APN Book 139 Page 330 Parcel 005 <br /> Township Range Section <br /> Location Sketch Activit <br /> Sketch must be drawn by hand after form isprinted.) O New Well <br /> North 0 Modification/Repair <br /> O Deepen <br /> O Other <br /> Destroy <br /> FIR Describe procedures and materials <br /> untler"GEOLOGIC LOG" <br /> 5- Planned Uses <br /> M-MRONWKTALf Water Supply <br /> ❑Domestic p Public <br /> i✓ s� w ❑Irrigation ❑Industrial <br /> Lill O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> 0Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> C South O Test Well <br /> [21ea�se <br /> �be <br /> �accu�rata�arid istance of well from roads,buildings,fences. O Vapor Extraction <br /> a map"use additional paper it necessary. O Other <br /> com tete. <br /> Water 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 550 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 550 Feet Test Length (Hours) Total Drawdown (Feet) <br /> *May not be representative of a well's long 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 Inches nches Inches Inches Feet to Feet <br /> 5 550 Fill Pipe Steel 15.5 5 550 Cement 40 yds. 10 SaCkMix <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 Salinas Pump Company <br /> ❑ Geophysical Log(s) Person.Firm or Corporption <br /> 21935 ROSehart WM Salinas CA 93908 <br /> O <br /> ❑ ther ater Chemical Analyses Address City State zip <br /> ❑ Other Signed �. 515945 <br /> Attach additional information if it exists. C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> DWR 188 REV 1/2006 IF ADDITIONAL SPACE IS NEEDED.USE NEXT CONSECUTIVELY NUMBERED FORM <br />