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The 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 Wriglnal Jth DWR State of California DWR Use Only—Do Not Fill In <br /> Well Completion Report I I <br /> Page of Refer to Instruction Pamphlet <br /> State Well Number/Site Number <br /> Owner's Well Number BH-1-2014 No. e0237748 INI I I I I I I w <br /> Date Work Began 08/11/2014 Date Work Ended 8/18/2014 Latitude Longitude <br /> Local Permit Agency San Joaquin County Environmental Health <br /> Permit Number Permit Date APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name City of Stockton <br /> Drilling Method Sonic Drilling Fluid <br /> Mailing Address 425 N EI Dorado St 2nd Floor <br /> Depth from Surface Description Stockton CA 95202 <br /> Feet to Feet Describe material, rain size,color,etc Ci State_Zip <br /> 0 30 Silty Sand Well Location <br /> 30 38 Sand Address 1320W Weber Ave. <br /> 38 40 Gravely Sand City Stockton County San Joaquin <br /> 40 109 Silty Sand Latitude N Longitude W <br /> 109 143 Silty Clay with Sand Dea. Min. Sec. Deq. Min. Sec. <br /> 143 160 Silty Sand Datum Dec.Lat. Dec.Long. <br /> 160 186 Silty Clay with Sand APN Book Page Parcel <br /> 186 228 Silty Sand Township -Ran e Section <br /> 228 256 Sand with Gravel Location Sketch Activit <br /> 256 280 Silty Sand with Clay Sketch must be drawn b lthand after form is rimed.) Qi New Well <br /> Q Modification/Repair <br /> Q Deepen <br /> O Other <br /> Q Destroy <br /> Describe procedures and materials <br /> under'GEOLOGIC LOG' <br /> Planned Uses <br /> Q Water Supply <br /> []Domestic ❑Public <br /> Lu ❑Irrigation []Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> G) Monitoring <br /> Drilled with 9"casing to 100'&then switched O Remediation <br /> to 8" O Sparging <br /> South O Test Well <br /> Illustrate or describe istance of well from roads,buildings,fences, O vapor Extraction <br /> rivers.etcand attach a map Use additional paper if necessary Q Other <br /> Please be accurate and complete <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 280 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 247.5 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 Type Material Wall Outside Screen Slot Size Depth from <br /> Surface Diameter yp Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 238 9"& 8" Blank PVC SCh 80 4 0 1227 Cement Portland <br /> 238 248 8" Screen PVC SCh 80 4 Slot 0.010 227 232 Bentonite Chips <br /> 232 250 Sand 1/20 <br /> 250 280 Bentonite Chips <br /> Attachments Certification Statement <br /> El 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 Cascade Drilling L.P. <br /> Person,Firm or Corporation <br /> El Geophysical Log(s) 3000 Duluth <br /> St A West Sacramento CA 95691 <br /> ❑ Soil/Water Chemical AnalysesgneA City state zip <br /> ❑� Other Site Map Sid 10/22/14 938110 <br /> Attach additional information,if it exists. -57-icensad WaterUJell Contractor Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />