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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 Original with DAR State of California r'DWRtJsa Onl -D6.NotFIIIIn <br /> Page 1 of 1 Well Completion Report <br /> Refer to Insfrudkm Pamphlet State Well Number/Site Number <br /> Owner's Well Number CT-MW-8-87 No. e0095040 �--tude 7� <br /> Date Work Began 06/23/2009 Date Work Ended 6/23/2009 LatiL1 J_J L I aria <br /> Local Permit Agency man Joaauin County Environm ntal Health D oartm nt � LI . <br /> Permit Number 57427 Permit Date 5/29/09 AWN/TRS/Other <br /> '. <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specity Name Sara Lee Bakery Group Inc. <br /> Drilling Method Hollow Stem Auger Drahng Fluid <br /> 'Depth from Surface Mailing Address 3500 Lacey Road <br /> Description Downers GrOve IL <br /> Feet to Feet Describe material rain sae color,etc - Cit -State_IL 60515 <br /> See attached eolo is boring logWell Location <br /> Address 1444 South Lincoln Street <br /> City Stockton County Sa .hcaguin <br /> Latitude N Longitude <br /> Dap. Min. Sec. Dec. Min. Sec. <br /> Datum NAD83 Decimal Lat..37.9367988 Decimal Long.-121.29341 <br /> APN Book - Page .. - Parcel <br /> Township 1 North Rene 6 East SeGtion 15 <br /> +Locatlon Sketch - Activit <br /> ' 3kelchmu'sCee tlrewn ` .handafter form is rioted 0 New all <br /> North 0 Modification/Repair <br /> 0 Deepen <br /> 0 Other <br /> 0 Destroy <br /> oeecnne Id...a"d melena[ <br /> UW8r'GE0L0G6 LOG' <br /> �P.,lannedllses 1 <br /> 0 Water Supply <br /> ❑Domestic ❑Public <br /> b ❑Irrigation ❑Industrial <br /> 0 Cathodic Protection <br /> 0 Dewatering <br /> 0 Heat Exchange <br /> ' 0 Injection <br /> e0 Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> South 0 Test Well <br /> mdaeaia m me[nmma.d[e m.enr.pm rsad.,eeialpp>.Imo... 0 Vapor Extraction <br /> firers,etc.end elhMem[q Use eUEXbna peer 11 necessary. 0 Other <br /> pne4 Ee a[wnb eM[pm Mb. <br /> ater.,Level aril Yeld*-Com"teles Wall . ' <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 87 Feet Estimated Yield (GPM) Test Type <br /> Total Depth of Completed Well 87 Feet Test Length (Hours)Total Drawdown (Feet) <br /> May not be representative of a well's lonq term yield. <br /> Casings, mil <br /> •.j " Annular,zterial <br /> Depth from Borehole Wali Outsie De th fromSurface Diameter Type Material Thickness DiameSurface FIII Description <br /> Feet to Feet Inches Inches InchFeet to Feet0 77 8.5 wiser Pvc Sch.40 20 1 cement Concrete <br /> 77 87 Screen PVC Son.4o 2 1 73 Grout Type II-IV Cement <br /> 73 75 nentonite 3/8"Bentonite Chi® <br /> 75 87 Filter Pack #2/12 Sand <br /> ` r.�".. .K r. , ''.`"• ' Certitl,etiori;3tatement" Y g <br /> Attachrnents.n'".trnr r a <br /> ❑� Geologic Log I,the underslgne n c h Is r rt is c let and accurate to the best of m knowledge and belief~ <br /> v❑ Well Construction Diagram Name Pa n Farm or, renin t <br /> ❑ Geophysical Log(s) Jfla Z CA <br /> ❑Other ter Chemical Analyses a 'Cay stele—,1��./i z;p <br /> O Other Mao Signed ``fir iD[� <br /> a add n In m Bit exists. ke Wakr Well ontraaor Date Sid.1 C-57 License Number <br /> DWR 188 REV 112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUrll NUMBERED FORM <br />