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ORIGINAL STATE OF CALIFORNIA DW R USE ONLY-DO NOT FILL IN <br /> File with DWR Vl.il COMPLETION REPORT <br /> Page 1 Of 1= Refer to Instruction Pamphlet STATE WELL NO/STATION NO <br /> Owners Well Number MW-3 e0014787 West <br /> Date Work Began 02103004, Ended 0903104 July 7,2004 LATITUDE LONGITUDE <br /> Local Permit Agency San Joaquin County APN Book Page Parcel <br /> Permit No.SRA 0036933 Peri[Dale 02/12r2004 APNITRS/OTHER <br /> Geologic Log Well Owner <br /> Orientation Vertical Name Mr.Victor Aranda <br /> Drilling Method Auger Fluid Mailing Address 5487 East Marsh Street <br /> Depth From Stockton California 95215 <br /> Surface Description Well Location <br /> Feel to Feet Deecrrue general matenal,grain sue,color.etc. Address 821 South Wilson Way <br /> 0-55 Drill out and abandon City Stockton <br /> County San Joaquin County <br /> APN Book Page Parcel <br /> Township Range <br /> west <br /> Location Sketch Activity <br /> North New well <br /> Planned Use <br /> Monitoring <br /> v n <br /> 3 w <br /> RE ED <br /> South <br /> JUL1 3 2004 Illustrate a(bsmee Disterea a well Iran Roads,8"eigs <br /> Fences Rivas,ekand attach a map Use addiborral paper N <br /> ENVIRONNItOT HEALTH necessary. PLEASE BE ACCURA TEAND COMPLETE. <br /> PERMITISERVICES Water Level and Yield of Completed Well <br /> Depth to First Water <br /> Depth to Static Water Level Date Measured <br /> Estimated YieldTat T„oa <br /> Totai Depth of Boring 55 Feet Test Length Total Drawdown <br /> Total Depth of Completed Well 55 Feet I-May be representative of weirs"term yield <br /> Casing Annular Material <br /> Deptho"E from l Material/ Internal Gauge/Wall Slot size, Depth from TYPE <br /> Surface DOL TYPE Grade Diameter Thickness if any Surface Filter Pack <br /> Feet lo Feet Ort) (In.) (In.) Feet to Feet (TypeS¢a) <br /> Attachments Certification Statement <br /> z Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> x Well Construction Diagram Name Cascade Drilling, Inc_ <br /> Geophysical Log(s) (Person,Fbm or co non)( o.Primed) <br /> Soil/Water Chemical Analysis mCi <br /> Address 3632 Oec Rancho Cordova Califomiz 95742 <br /> x Other Site Map Sigrid C 5 LICENSE NUMBED 717510 <br />