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''The free Adobe Reader may be used to view and compl�form. However,software must be purchased to complete, nd reuse a saved form. <br /> File Original with DWR State of California DWR Use Only—Do Not Fin In <br /> Page of Well Completion Report <br /> Referee Instruction Pamphlet <br /> Date Work Began 11/26/2014 Date Work Ended 11/26/201414 <br /> Ownels Well Number MW-3 NStale WeII Number/Site Number <br /> o. /02f�-�-'I <br /> Latiw t� Lon nude <br /> Local Permit Agency San Joaquin County Ea&Qnm ntal Health <br /> Permit Number 70661 Permit Date 9/30/14 APN/TRS/Other <br /> Geolo is Lo - Well Owner <br /> Orientation O Vertical O Horizontal OAngle specify Name CA Army National Guard <br /> Dolling Method Auger Drilling Fluid <br /> Depth from Surface Mailing Address 10260 Mather Blvd. <br /> P Description <br /> Feet to Feet Describe material,grain size,color,etc City Mather State-CA—zip 95655 <br /> Overdrill to abandon 4"well to 61'and grout to - —Well Location <br /> surface Address _2000 Stimson Road <br /> city Stockton County San Joaquin <br /> Latitude N Longitude <br /> Dec. Min, Sec. Dep. Min. Sec. <br /> Datum Dec.Lat. Dec.Long. <br /> APN Book Page Parcel <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 /> — <br /> @ Destroy <br /> Dmmtra pewee am materials <br /> umx'GEOLOGICLOG' <br /> Planned Uses <br /> O Water Supply <br /> E]Domestic []Public <br /> 3 e ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> 0 Injection <br /> O Monitoring <br /> O Remediation <br /> O Spangling <br /> South O Test Well <br /> Illustrate ordmcdtre distance ofeaii rmmds,auseve:,ream, O Vapor Extraction <br /> ®a.aa.am avaph a map.use addiom.pai pepar dnereesary. O Other <br /> Par treeaaamus <br /> _and corn k1.. <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 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 I,the undersigned,certify that this report is Complete and accurate to the best of my knowledge and belief <br /> 1:1 Well Construction Diagram Name Cascade DrillinO L.P <br /> Person,Firm or Corporation <br /> 11 Geophysical Log(s) 3000 Du h St West Sacramento CA 95691 <br /> 11SoillVJater Chemical Analyses In�dQ s City seat; zip <br /> El Other Site Mao Signed ]� ✓ 12/12/14 938110 <br /> Attach additional in(ormalion,it it exists. C-67 Ucens Water Wait contra tor Date Signed C-57 License Number <br /> DWR 188 REV.12006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />