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The free Adobe Reader may be used to view and complform. However,software must be purchased to complete, no reuse a saved form. <br /> File Original with DWR State of California DWR Use On! —Do Not Fill In <br /> Page of Well Completion Report <br /> Refer to Instruction Pamphlet <br /> Owner's Well Number MW-1 No. eO246375 buns Well Number/Site Number <br /> Date Work Began 11/26/2014 Date Work Ended 11/26/2014 <br /> Latitude <br /> Longitude <br /> Local Permit Agency San JoaaLin County Environmental Health <br /> Permit Number 70661 Permit Date 9/30/14 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specity 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,gmin size.color,etc City Mather State CA Zi 95655 <br /> Overdrill to abandon 4"well to 60'and grout to Well Location <br /> surface Address 2000 Stimson Road <br /> City Stockton County San Joaquin <br /> Latitude N Longitude —5e—o--_____wOep. 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.) —5 New Well <br /> North 0 Modification/Repair <br /> 0 Deepen <br /> 0 Other <br /> Destroy <br /> unde,m.lac OGIC Lead m :rials <br /> uMc'GEGLOGIC LOG" a <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic E]Public <br /> 3 w ❑lnigation ❑Industrial <br /> 0 Cathodic Protection <br /> 0 Dewatering <br /> 0 Heat Exchange <br /> 0 Injection <br /> 0 Monitonng <br /> 0 Remediation <br /> 0 Sparging <br /> South 0 Test Well <br /> nlwndeardescdbedavnce Orwell rren mds,bulalrgs.rte, 0 Vapor Extraction <br /> n ., .amewmamac.u.a aaddlorelwwrlrna�arv_ 0 Other <br /> ewo.be aeeueate and corn lei.. <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 a (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 b6h-lf <br /> 11 Well Construction Diagram Name Cascade Drilling L.P. <br /> ❑ Geophysical Log(s) Person,Finn or Corporation <br /> 3000 Dul St West Sacramento CA 95691 <br /> ❑ Soil/Water Chemical AnalysesCry sista zip <br /> O e�r Other Site Mao Signed hbea/ 12/12/14 938110 <br /> Attach addilonal information.if It exists. C-57 Licensed Water ell con rac or Date Signed C-57 License Number <br /> DWR 188 REV.!2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />