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"The free Adobe Reader may be used to view and comr,his form. However,software must be purchased to Doorplate.a' "Ind reuse a saved form. <br /> File Original with DWR State of California <br /> Page 16 of 18 Well Completion Report <br /> Owner's Well Number IW-3 Refer tofriarwNonNmphfef' State well NumberlSiteNumber <br /> Date Work Began 04/16/2012 No• e0150792 N JW <br /> AI <br /> Date Work Ended Latitude Lon itude <br /> Local Permit Agency San Joaauln Cnun -Env!ro Mental Ha Ith.Denagme.nt <br /> Permit Number Permit Date 2129/12 APNlTRSfOther <br /> law <br /> Orientation OVertical 0Horizontal OAngle Specify <br /> Drilling Method Auger Name Wight Holdin s Inc. <br /> .1 Drilling h r r Drilling Fluid Mailing Address`130 S.Wilson Way <br /> Ma <br /> _ _ ^ <br /> j' C State 7i Stockton CA 95205 <br /> 0 60 Overdrill 314 inch Well to 60 feet. <br /> Address 130 S.Wilson Way <br /> City StoC ttonSan Joaquin <br /> Co ty 4 <br /> Latitude gltud _^w <br /> [leo. Min. 5 open. M��fi 'Sec. <br /> Datum Degimai La DecimalJy'Rong .p6 <br /> APNBook "Page �iParcei40 <br /> Townshi a pn <br /> x 1 <br /> '* .i.. <br /> sl4r� t `s O Ne`�v Well <br /> Mo IficationlRepair <br /> Deepen <br /> Mho s O Other <br /> Destroy:: <br /> Desedhe procedures and materials <br /> n under'GEOLOGIC L07 <br /> z <br /> iiN Vr O Water Supply <br /> []Domestic []Public <br /> ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewaterin <br /> . � O Heat Exchange <br /> # ; O Injection <br /> x. � [] Monitoring <br /> fiY O Remediation <br /> South O Test Well <br /> r :II!strata or dear ibe distance of mil from Made,buildinW.tenbM, O Vapor Extraction <br /> Nem etc.and attach a map.Use additional paper if necese <br /> _. Pkam be ecaurata and cam �' '�other <br /> , <br /> ro'ax - <br /> R l r Depth to first water (Feet below surface) <br /> Depth to Static <br /> r5 'Water Level (Feet) Date Measured <br /> Total Depth of Qgring Feet Estimated Yield' (GPM) Test Type <br /> Cmc: <br /> Total Depth cf Completed Well kt � Feet Test Length (Hours).Total Drawdown (Feet) <br /> # I I* ay not be re resentative of a well's long term yield. <br /> Depth from S1rehole Wtl+late WP. Wall Outside Screen slot size Depth from <br /> Surface Diime6 ,, T Thickness Diameter Type. If Any Surface t=ill Description to Feet Incties' r^.r Inches Inches Inches Feet to Feet <br /> y <br /> M <br /> ❑ <br /> Geologic Lo <br /> rN <br /> 77::77Date <br /> rtify that this report is corn late and accurate tp th_g g P e best of my knowledge and belief <br /> Well Construction Diagram rilling.LP_ _ _ <br /> or Corporation❑Geophysical Log(s) eRancho Cordova 957 2❑SolllWater Chemical Analyses reacity s�� Zip <br /> 0 Other Site M 4/26/2012 938110 <br /> ttach additional Information Ir it edsts. ed w ell Can or Date Si ned C-57 License Number <br /> DWR 189 REV.1!1009 IF ADDITIONAL SPACE-IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />