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'The free Adobe Reader maybe used to view and complethnfdform. However,software must be purchased to comp)=te,sao,,lll,,,lad reuse a saved form. <br /> File Original with DWR State of California _ DWR Use Only—Do Not Fill In <br /> Well Completion Report <br /> Page 1 Of 1 Refer Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number MW-2 No. e0239319 —t I N w <br /> Date Work Began 08/25/2014 Date Work Ended 9/4/2014 _ _ Latitude Longitude <br /> Local Permit Agency San Joaoffin County Environmental Health Department J. <br /> Permit Number 70176 Permit Date 6/30/14 I,__, APNJTRS/Other <br /> Geologic Lo , __. Well Owner <br /> Orientation OVertical O Horizontal OAngle Specify Name San JoaC„in C:,unty <br /> Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address 1'0 Bf;x 1810 <br /> Depth from Surface Description Stockton CA 95201 <br /> Feet to Feet Describe material, rain size,color,etc City State_moi <br /> 60 0 Overdrill 21r Well Location <br /> Address 2662 P;,V'ris;ln Way <br /> City Stockton ,._ County San Joaquin <br /> Latitude _ N Longitude <br /> Deo. lin. Sec. Deq. Min. Sec. <br /> Datum Doc. Lat. 37.982692 Dec.Long.-121.271377 <br /> AF'N Book 1_7 Page 060 Parcel 33 <br /> Township _R:1n a Section <br /> LocolioT.Aetch Activity <br /> Sketch must be dra r,.I b• her,d after forth isprinted.) O New Well <br /> N xtl; O Modification/Repair <br /> O Deepen <br /> O Other <br /> O Destroy <br /> Describe procedures and materials <br /> under'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> []Domestic ❑Public <br /> u w ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> (j) Monitoring <br /> O Remediation <br /> O Sparging <br /> S gull l O Test Well <br /> Illustrate ce describe dieter,r of roti lam roads.buildings,fences. O Vapor Extraction <br /> dvr:rs,etc.and attach a rn I� us 9 acr itional paper it necessary. O Other <br /> Please be accurate and <br /> Water Level all "ic d of Completed Well <br /> Depth to first wa::r, (Feet below surface) <br /> Depth to Static <br /> Water Level _..__, (Feet) Date Measured <br /> Total Depth of Boring 60 Feet Estimated Yield ' __, (GPM) Test Type <br /> Total Depth of Completed Well 60 Feet <br /> Test Length _. (Hours) Total Drawdown (Feet) <br /> 'tAay not be rep sentalive of a well's long term yield. <br /> Casings Annular Material <br /> if <br /> Depth from Borehole Type Material wall Outside Screen SiSi:E"' <br /> ::t tie from <br /> Surface Diameter Thickness Diameter Type f Arr• Surface <br /> face Fill Description <br /> Feet to Feet Inches Inches Inches Inches Flet to Feet <br /> Attachments CertificliRn Statement <br /> ❑ Geologic Log 1,the undersigned,certify that this report is comp AE and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name All well Abandonment inc. <br /> Person,Firm or Corporation <br /> ❑ Geophysical Log(s) 3369 Fitzgerald ROad,_St�ef .B :"�1 nc 10 --ordova CA 95742 <br /> ❑ So I/Water Chemical Analyses Address=;✓. — coy State zip <br /> [D Other Site Mao Signed . - %�, _ _ 10/31/2014 848359 <br /> Attach addiUoral information 6 it exists. /``8=57 nse el or _ Date Signed C-57 License Number <br /> DWR 188 REQ'.112OD6 IF ADDITIONKL SPACE IS NEEDED,USE NEXT CONSECUTI',f LY NLIABERED FORM <br />