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"The free Adobe Reader may be used to view and iiete this form. However,software must be purchased to com• save,and reuse a saved form. <br /> File Original with DWR State of California <br /> Page 1 of 1 Wel[ Completion Report DWR Use Onl Do Not Fill In <br /> Refer to lnslrudion parnphlef <br /> Owner's Welf Number MW-2 NO- el State Well Number/Site Number <br /> Date Work Began 10/29/2007 Date Work Ended 10129/2007 NTia= W <br /> atitude <br /> Local Permit Agency n oa ,i nt n <br /> nvir nm t ! Health D m LJ I Lon nude <br /> t , <br /> Permit Number 4 8 Permit Date 1116107 APNI I Kwulher <br /> Geolo is Lo <br /> Well Owner <br /> Orientation OVertical 0Horizontal OAngle specify <br /> Drilling Method Name Atlantic Richfield Company „ <br /> Drilling Fluid : <br /> Depth from SurfaceDescriptitl Mailing Address 6.CentelDrive <br /> Feet IO <br /> Feet' -Describe materiat rain size,color,etc Cit La alma Slate-CA i <br /> Destroyed by overdrilling and filling borehole with Well Location <br /> neat cement grout. Address 1617 West Fremont Street <br /> City Stockton County San Joaquin <br /> Latitude N Longitude w <br /> Dep. Min. Sec. Dep. Min, Sec, <br /> Datum Decimal Lat. Decimal Long. <br /> APN Book 135 Page 11 Parcel 015' <br /> Township Rari a Section <br /> Location Sketch - Activit <br /> '(Skelch must be drawn by hand after forlT.is rinted:n� .0 NewWell <br /> North <br /> Li Q Modification/Repair <br /> O Deepen <br /> O Other <br /> - <br /> G Destroy <br /> Dnaibe Arocedvree and materials <br /> under'GEOLOGIG LOG' <br /> Planri6 Uses <br /> Q Water Supply <br /> ❑Domestic ©Public <br /> w ❑Irrigation []industrial <br /> 0 Cathodic Protection <br /> O Dewatering <br /> 0 Heat Exchange <br /> O Injection <br /> Q Monitoring <br /> Q Remediation <br /> IFE O Sparging <br /> South Q Test Well <br /> Illuw le m describe dill....efacll from roads,buildings,lero", O Vapor Extraction <br /> river.,etc.and attach a map.Use additional paper if necessary. O Other <br /> Please be-urate 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 Feet Estimated Yield` (GPM) Test Type <br /> Total Depth of Completed Well Feet Test Length (Hours) Total Drawdown (Feet) <br /> *May not be representative of a well's long term yield. <br /> :Casings. <br /> 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 Inches Inches Inches Feet to Feet <br /> Attachments Certification'Statement "` <br /> ❑ Geologic Log 7AI�an <br /> d,certify that this report is complete and accurate to the best of my knowledge and belief <br /> © Well Construction Diagram ddin Stratus Environmental, Inc. <br /> ❑ Geophysical Logs) ,Firm or Corporationn Park Dr.. Suite 550 Cameron Park CA 95682 <br /> ❑ SoilNYater Chemical AnalysesA s city State zip <br /> El Other Site Plan lwrt`I,�t 1112107 71p079 <br /> Attach etldilional information,it it existsIcerlsed Water Well contractor Date Signed C-57 License Number <br /> DWR 188 REV,112406 1F ADDrnONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />