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'The free Adobe Reader may be used to view and complete form. However,software must be purchased to comp):t>, ay.vl reuse a saved form. <br /> File Original with DWR State of California __. DWR Use Only-Do Not Fill In <br /> of Refer to instruction Pa1 Well Completion Report --T-T7-T--1,�� <br /> Page 1 mphlet _ State Well Number/Site Number <br /> Owner's Well Number MW-3 No. e0239320 ���_ W <br /> Date Work Began 08/25/2014 Date Work Ended 9/4/2014 _ Latitude Longitude <br /> Local Permit Agency r + G rnnmantal Haalth nPnnrtment CJ_- 1 1 1 1 <br /> APN/T 1 Other <br /> Permit Number 70176 Permit Date 6/30/14 <br /> Geologic Log Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specify. Name San JOag,ln _ujnty <br /> Drilling Method Hollow Stem Au er Drilling Fluid Mailing Address j;:2.Lc,.( 1810 <br /> Depth from Surface Description Cit/ Stockton ::=e State_CA__zip 95201 <br /> Feet to Feet Describe material rain size,color,etc <br /> 60 0 Overdrill 2" _ Well Location <br /> Address 2662 h„lhisrn Way <br /> City StocktonCounty San Joaquin <br /> Latitude _ , N Longitude <br /> Deo. N in. Sec. Dep. Min. Sec. <br /> Datum . De c.i-at. 37.982692 Dec.Long.-121.271377 <br /> APN Book 117 ,._ Page 460 Parcel 33 <br /> Township _R<I a Section <br /> Loc-.lt io i!i ketch Activit <br /> Sketch must be dra,r b�ha:d after form is rinted. Q New Well <br /> ,.N.irit O Modification/Repair <br /> Q Deepen <br /> 0 Other <br /> Q Destroy <br /> Describe procedures and materials <br /> unde,'GEOLOGIC LOG' <br /> r1nd Uses <br /> pplyic ❑Public <br /> wn ❑Industrial <br /> ni <br /> Protectionnghange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> ou h Test Well <br /> 0 Vapor Extraction <br /> Illustrate or describe dint.,'.of veli f om roads,buildings,fences. O <br /> mors,etc.and attach am i) u,a ad,litbnal paper if necessary. Othe( <br /> Please be accurate and,:�n2Lr to. <br /> 1.—�. <br /> ater Level al' i'field of Completed Well <br /> Cepth to first wall r,_, (Feet below surface) <br /> Cepth 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 /> •IVlay not be repr s(nt:tive of a well's long term yield. <br /> Casings _ Annular Material <br /> Depth from Borehole Type Material wall Outside Screen Slot Si i„ Depth from <br /> Surface Diameter Thickness Diameter Type ifAn1 Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches) l:set to Feet <br /> Attachments Certifi( stion,Statement <br /> ❑ Geologic Log I,the undersigned,certify that this report is com;l et a and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name All well Abandonment Inc. <br /> g Person,Firm or Corporation <br /> ❑ Geophysical Log(s) 3369 Fitzgerald ROad, SuitE�6,�-��i'•P4cho Cord <br /> CA 95742 <br /> ❑ Soil/Water Chemical Analyses Address' .! —"' City State zip <br /> 0 other Site Mai) Signed _ 10/31/2014 848359 <br /> nse� actor � �� _� Date Signed C-57 License Number <br /> Attach additional information if it exists. , <br /> DVJR 188 REV.1/2018 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUT'v=L"N1.MBERED FORM <br />