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`The free Adobe Reader may be used to view and compl�form. However,software must be purchased to complete,s d reuse a saved form. <br /> File Original With DWR State of California DWR Use Only—Do Not Fill In <br /> Page of Well Completion Report <br /> Refer to Instruction Pamphlet Stale Well <br /> Owner's Well Number MW-4 No. e0246373 Number/Site NumberT—I-I <br /> Date Work Began 11/26/2014 Date Work Ended 11/26/2014 Lati�t dwJ Lon�Ll—IJ <br /> Local Permit Agency-San Joaauin County Environmental Health <br /> Permit Number-20-661 Permit Date 9/30/14 APNrrRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name CA Army National Guard <br /> Drilling Method Auger Drilling Fluid <br /> Depth from Surface Description Mailing Address 10260 Mather Blvd. <br /> Feet to Feet Describe material,grain size,color,etc City Mather State CA zi 95655 <br /> Overdrill to abandon 4"well to 50'and grout to Well Location <br /> surface Address 2000 Stimson Road <br /> City Stockton County San Joaquin <br /> Latitude N Longitude _-97n -in. �N <br /> Deft. Min. Sec. Dae. MSec. <br /> Datum Dec.Lat. Dec.Long. <br /> APN Book Page Parcel <br /> Township Ran a Section <br /> Location Sketch Activit <br /> (Sketch must be drawn by hand after form Is rimed.) Q New Well <br /> North <br /> 0 Modification/Repair <br /> O Deepen <br /> O Other <br /> (D Destroy <br /> Deavibe pmcmuresaM malenels <br /> order'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic [I Public <br /> 3 w ❑Irrigation El Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> Monitoring <br /> O Remediation <br /> O Spangling <br /> South O Test Well <br /> Illuabmeordwcfle dhmnm aweu fmm load.,bmuimss.remces, 0 Vapor Extraction <br /> Fers.ec..m,mGi.mev.uaeaddnunalpeperiln. ., OOther <br /> lo.s.W ssunre and tom l.W. <br /> Water Level and Yield of Com p leted 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 /> EVE <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 Cascade Drillino. L.P. <br /> Person,Firm or Corporation <br /> ❑ Geophysical Log(s) 3000 Dul St West Sacramento CA 95691 <br /> El Soil/Water Chemical Analyses dd a aly stale Zip <br /> EDOther Site Mao Signed 12/12/14 938110 <br /> Attach additional information.Hit edsts. -7 cersearWate,Well Convector Date Signed C-57 License Number <br /> DWR 188 REV.12006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />