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I` "The free Adobe Reader may be used to view and com his forth. However,software must be purchased to complete,s' ''nd reuse a saved form. <br /> File Original with DWR . <br /> State of California <br /> Page 14 of 18 Well Completion Report <br /> Owner's Well Number IW-1 Refer to lnsrncson Pamphlet State Well NumberlSRe Number <br /> Date Work Began 0411 3120 1 2 HO e0150784 <br /> g Date Work Ended 411312012 W <br /> Local Permit Agency San J0aCljWnartment — Latitude Longitude <br /> Permit Number Permit Date 2129112 �APNrrRSW�10ther , <br /> II <br /> Orientation O Vertical O Horizontal OAngle Specify <br /> Drilling Method A Drilling Fluid <br /> Auger Name Wight Holdings,Inc. <br /> � ' <br /> Mailing Address 130 S.-Wilson Way <br /> ell C Sfockton _ State CA �i 95205 <br /> 0 60 Overdrill 314 inch well to 60 feet. <br /> I <br /> Address 13 S:Wilson Lia <br /> City Stockton `` Co@t ty,San Joaq uin <br /> Latitudegitude ,: a w <br /> Den. Min. -Sen. Min. ;sec <br /> Datum, Decimal L aft Decima_k'bng <br /> APN Book Pa a arm r — <br /> Townshi an <br /> MOVE <br /> r <br /> : t..•t+lorthO N a NRepair}�§ �� 'O Dn• <br /> Av� 0 Other <br /> "0r, _�, O Destroy <br /> ":"?$ ''•_>.- " n. Desmibe proceduresaM motaials <br /> tea. under•cE0=;GLoc <br /> «-' sr O.Water Supply <br /> ^. { - ❑Domestic ❑Public <br /> m w irrigation ©Industrial <br /> �.' O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> 0-Injection <br /> O.Monitoring I <br /> « •, �, ,. O Remediation <br /> O Sparging <br /> LL' O Test Well <br /> South <br /> ihuatrote a dean be de[ance al„en tram roads.etbu9dl�re se cea. O Vapor Extraction <br /> rWera c and attach a map,use swillonal paper d necessary. 0 Other <br /> '�.�:. 'y: �,:, pisses W acwrme antl cam <br /> ..-. <br /> off. S:. <br /> x ; <br /> Depth to first water _ (Feet below surface) <br /> Depth to Static , <br /> < r Water Level (Feet) Date Measured I <br /> Total Depth of Bortng" 'f'0 s a, Feet Estimated Yield* (GPM) Test Type ' <br /> _R. <br /> Total Depth ompleted Well " - £ 'Feet Test Length (Hours) Total Drawdown (Feet) <br /> *May not be re resentative of a well's long term yield. <br /> Depth fromMa WWI" <br /> rehole , `° wall Outside screen slot size Depth from ; <br /> Surface ptgtgr yPa :,q lNaterll Thickness Diameter Type If Any surface Fill Description i <br /> Feet to Feet Inc 6s' inches Inches Inches Feet to Feet <br /> f <br /> Jaz <br /> ❑Geologic Log. LName <br /> rsigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram D •Ili <br /> Person,Finn or Corporation <br /> ❑Geophysical Log(s) mec Circle ;Rancho Cordova SCA .99742 <br /> ❑Soil/Water Chemical Analyses Add a city" Stage Zip <br /> 0 Other Sit a 4/26/2012 938110 <br /> Attach additionat information if it e*ts. C-57 Licensed Water ell co ctor Date Signed C-57 License Number <br /> DWR IN REV.1!2008 IF ADDITIONAL SPACE IS NEEDED,I ISIKEXT CONSECUTIVELY NUMBERED FORM - I <br /> s <br /> ' I <br /> I <br />