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The free Adobe Reader may be used to view and complete this form. However,software must be purchased to complet ve,and reuse a saved form. <br /> File Original with DWR ..ell State of California DWR Use Only—Do Not Fill In <br /> Page Well Completion Report �—� <br /> ge oRefer to instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number MW-2 No. e0236531 N W <br /> Date Work Began 09/29/2014 Date Work Ended 9/29/2014 Latitude Longitude <br /> Local Permit Agency San Joaquin County Environmental Health F 1 I iI I I , <br /> Permit Number 70557 Permit Date 9/15/14 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name Chevron Environmental Management <br /> Drilling Method Drilling Fluid Mailing Address 6111 Bollinger Canyon Road <br /> Depth from Surface Description <br /> Feet to Feet Describe material,grain size,color,etc city San Ramon State CA lip 94583 <br /> Pressure grout to abandon 2"well to 40' Well Location <br /> Address 242 N Sutter Street <br /> 'Destroyed by placing det cord downhole, City Stockton County San Joaquin <br /> grouting, detonating, &topping off with additional Latitude N Longitude W <br /> grout Dea. Min. Sec. Dea Mir 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.) Q New Well <br /> North <br /> Q Modification/Repair <br /> O Deepen <br /> O Other <br /> Q Destroy <br /> Describe procedures and materials <br /> under•GEOLCGIC LOG' <br /> Planned Uses <br /> Q Water Supply <br /> ❑Domestic ❑Public <br /> m ❑Irrigation [:]Industrial <br /> w <br /> Q Cathodic Protection <br /> Q Dewatering <br /> Q Heat Exchange <br /> Q Injection <br /> Q Monitoring <br /> Q Remediation <br /> Q Sparging <br /> South Q Test Well <br /> Mustrate or describe distance of wen rrnm roads,buildings.fences. Q Vapor Extraction <br /> rivers.etc.and attach a map Use 11,14unal paper Ir necessary Q Other <br /> Please be accurate and corn lista <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 /> FTotalDepth of Boring Feet Estimated Yield" (GPM) Test Type <br /> 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 TWall 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) Feel 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 /> ❑ Well Construction Diagram Name Cascade Drilling, L.P. <br /> ❑ Geophysical Log(s) Person,Firm or Corporation <br /> 3000 Dulut St West Sacramento CA 95691 <br /> ❑ Soil/Water Chemical Analyses -- City State zip <br /> El Other Site Map Signed 10/14/2014 938110 <br /> Attach additional information,if it exists. C d r-57 Lice a Water Well Contractor Date Signed C-57 License Number <br /> DWR 188 REV,112006 IF ADDITIONAL SPACE IS NEEDED IISF NFXT CrINSFCI ITIVFI V NI IAARPP] F`i 111- <br />