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'The free Adobe Reader may be used to view and complet;st .form. However,software must be purchased to comph ee,s=%,, �i reuse a saved form. <br /> File Original with DWR State of California _ DWR Use Only—Do Not FII!In <br /> Well Completion Report [ I--T-7 1 T I—T-1--�Z� <br /> Page 1 Of 1 Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number VEW-1 No- e0239323 I I i W <br /> Date Work Began 08/25/2014 Date Work Ended 9/4/2014 _ _ Latitude Longitude <br /> Local Permit Agency San Joaau4n'' "^+"Enyirnmenfal Hoalth Department C_.. I 1 1 1APNrrRS10ther <br /> Permit Number 70176 Permit Date 6/30/14 <br /> Geolo is Lo __ Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specify Name San Joaqu n Ccunty <br /> Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address_;'2.g(IK 1810 <br /> Depth from Surface Description Stockton StateC_A_Zip 95201 <br /> Feet to Feet Describe material,grain size,color,etc City <br /> 53 0 Overdrill4" __ Well Location <br /> Address 2662�1. 6isf,n Wa <br /> City Stockton ,.__, County San Joaquin <br /> Latitude N Longitude _-N <br /> Oea. A in. Sec. Dea. Min. Sec. <br /> Datum Doc. _at. 37.982692 Dec.Long.-121.271377 <br /> APN Book 117 _ F age 060 Parcel 33 <br /> Tcwnship _Ran a Section <br /> Loc;Ilion!Retch Activit <br /> Sketch must be dra l._i b, hal.d after form is rinted. New Well <br /> N trtit O Modification/Repair <br /> O Deepen <br /> O Other <br /> O Destroy <br /> Describe procedures and metal- <br /> under'GEOLOGIO LOG' <br /> Planned Uses <br /> Q Water Supply <br /> []Domestic []Public <br /> w OIrrigation [:]Industrial <br /> ID <br /> O Cathodic Protection <br /> 0 Dewatering <br /> O Heat Exchange <br /> O Injection <br /> 0 Monitoring <br /> O Remediation <br /> 0 Sparging <br /> 0 Test Well <br /> :ou,t <br /> Illustrate or describe dist.:: <br /> of vent om roads,buildings,fences. O Vapor Extraction <br /> riv.-ra,etc.and attach am t) U:a ed Gtional paper if necessary. O Other <br /> Please be accurate and r nil t�. <br /> nater Level a,i f ffilld of Completed Well <br /> Depth to first wa'c!r, (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet} Date Measured <br /> Total Depth of Boring 53 Feet Estimated Yield" (GPM) Test Type <br /> Total Dep'h of Completed Well 53 Feet <br /> Test Length (Hours) Total Drawdown (Feet) <br /> Lay not be repIf se nt:tive of a welts long term yield. <br /> Casings _ Annular Material <br /> Depth from Boreholewall Outside Screen Slot Si;,, i)epth from <br /> Surface Diameter Type Material Thickness Diameter Type ifAnl Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inche ' 1:--et to Feet <br /> Attachments Certitic. tion.Statement <br /> ❑ Geologic Log I,the undersigned,certify that this report is com;r et f and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name Al well Abandonment inc. <br /> Person,Firm or Corporation <br /> Geophysical Log(s) 3369 Fitzgerald Road. fB n(h,J,t Cordova CA 95742 <br /> ❑ Soil/Water Chemical Analyses Ad�ras�". -/ City State zip <br /> y / "l^ .. <br /> El Other Site Map Signed _ 10/31/2014 848359 <br /> Attach additional information it it e)dsts. i"'� a ,. Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL S15ACE IS NEEbED,USE NEXT CONSECUT'i=L"N.MBERED FORM <br />