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'The free Adobe Reader may be used to view and complete this:toi to However,software must be purchased to complete.save.and reuse a saved form. <br /> File Original with DWR State of California DWR use only—Do Not FBI In <br /> A,:,ll Completion Report <br /> Page 1 of 1 Refer to Instruction PampMer State Wall NumbeUSite Number <br /> Owner's Well Number MW-2 No. e02T01031 Wr <br /> Date Work Began 04/28/2015 Date Wok ?n: ed 5111/201 LatitudN I e Longitude <br /> Local Permit Agency Gan Joaquin County EnyironlT l,',,[LB.;iealth DeDar'ment I gpN/rRS/01her <br /> Permit Number Permit Date --.. — <br /> Geologic Log Well Owner <br /> Orientation OVertical 0Horizontal OAn IN Specify__ Name Huntbrook Holdings LLC <br /> Dolling Method Hollow Stem Auger Drillirg 1' lid Bentonite mud Mailing Address 2351 Sunset Blvd#170-717 <br /> Depth from Surface Descri:tiro - Cit Stockton State Ca 7i 95205 <br /> Feet to Feet Describe material min:tzi_.color etc <br /> 115 0 Drill sam IS,and install MonitcrViell Well Location <br /> using hollow stem augers .-- . Address 3138 E main Street - <br /> -- City Stockton _County San Joaquin <br /> Latitude N Longitude _-P—,n <br /> --"' Dece. Min. Sec. Dep. Sec. <br /> ---' Datum Dec.Lat. Dec.Long. <br /> ---" APN Book Page Parcel <br /> --- Townshi Range Section <br /> '--- Location Sketch Activity <br /> -- Sketch must be drawn by hand atter roan is anted. O New Well <br /> North Modification/Repair <br /> O Deepen <br /> --" O Other <br /> _-.. O Destroy <br /> Desvibe poceEum eM malabb <br /> .--.. unae�'GEOLOGIG LOG' <br /> ---. Planned Uses <br /> ---. O Water Supply <br /> .--., <br /> []Domestic E]Public <br /> ❑Inigation ❑Industrial <br /> O Cathodic Protection <br /> _ O Dewatering <br /> O Heat Exchange <br /> ---" O Injection <br /> --- O Monitoring <br /> --- O Remediation <br /> Springing <br /> O Test Well <br /> --" South O Vapor Extraction <br /> rid aSa0.tm..c�u.<.entmap o�n:°e'e6"eCCS. O Other <br /> --' ple.-ceetc.c ..II eem bre. <br /> --- ater Level and Yield of Complete Well <br /> --- Depth to first water (Feet below surface) <br /> ---.. Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 115 --.,_ Feet Estimated Yield` (GPM) Test Type <br /> Test Length (Hours) Total Drawdown_(Feet) <br /> Total Depth of Completed Well 115 .--.,_ Feet •Ma not be re resem alive of a well's Ion term field. <br /> Annular Material <br /> Casirl�-., <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Meterl d Thickness Diameter Type if Any Surface Fill Description <br /> Feet 10 Feet Inches -- Inches in <br /> Inches Feet to Feet <br /> 115 95 8 Screen PVC Sch.40 — 2 y Milled Slots 0.010 115 93 Filter Pack #2112 sand <br /> 95 0 8 Blank PVC Sch. -- 2 93 91 Bentonite pellets <br /> g1 Cement portland 1/II <br /> Attachments -. Certification Statement <br /> ❑ Geologic Log �l,tt:e .ndersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Win 3 All Well Abandonment Inc <br /> g Pemon,Firm x Corporation A 95742 <br /> ❑ Geophysical Log(s) _3(1,1 Fitzgerald Rd Rancho Cordova <br /> city state zip <br /> ❑ SoiWVater Chemical Analyses AddrSi,in,I:1 G 6/5/2015 848359 <br /> El Other site map C-67 a eai weteWcontrecta Date Si ned C-57 License Number <br /> Atte adtiticnal tntamason d d sksls. <br /> DWR 188 REV.10006 IF-DI,"ZONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />