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'The free Adobe Reader may be used to view and complet1�4 form. However,software must be purchased to compo e,s=+,,,�d reuse a saved form. <br /> File Original with DWR State of California __. DWR Use Only-Do Not Fill In <br /> 1 Well Completion Report [� ;T I I , <br /> Page 1 of Refer to Instruction Pamphlet _ State Well C Number/Slte Number <br /> Owner's Well Number VIEW No. e0239327 N I I W�- Lon itude <br /> Date Work Began 08/25/2014 Date Work Ended 9/412014 _ _ Latitude <br /> County Environmental Health Department . <br /> Local Permit Agency � --- APN/TRS/Other <br /> Permit Number 70176 Permit Date 6/30/14 <br /> Geologic Lo I Well Owner <br /> Orientation (E)Vertical O Horizontal OAngle Specify Name San Joac.-,in C:,unty <br /> Drilling Method Hollow Stem Au er Drilling Fluid Moiling Address,I:Q Brx 1810 <br /> Depth from Surface Description Cil Stockton State Com`_Zi 95201_9 <br /> Feet to Feet Describe material, rain size,color,etc Y <br /> 25 0 Over rill 4" __ Well Location <br /> Address 2662 f;, V/ison Way - <br /> City Stockton County San Joaquin <br /> Utitude _ N Longitude -� <br /> Deo, i Ain. Sec. Dee. Min. Sec. <br /> Datum ,. D>c Lat. 37.982692 Dec.Long.-121.271377 <br /> APN Book 117 ,._ 1:age 060 Parcel 33 <br /> Tilwnship _.:_.R;In a Section <br /> Loclttic n Sketch Activity <br /> (Sketch must be do i+n t Lh id after form is rinted. O New Well <br /> ��rlli O Modification/Repair <br /> O Deepen <br /> 0 Other <br /> — <br /> (j) Destroy <br /> Deswlbe procedurea and materials <br /> under'GEGLGGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> 3 w ❑Irrigation ❑Industrial <br /> Q Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> 0 Sparging <br /> O Test Well <br /> Ir �le3o:th Q Vapor Extraction <br /> t. <br /> lustrate a describe dist i•:e a I M I from roads,buildings,fences, O <br /> vers,etc.and attach a i r p. Ise a dditional paper if neceeaary. Other <br /> kasabeaccurateG, <br /> MM Nater Level laid Y',?Id of Completed Well <br /> Depth to first w:t:er (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Feet Estimated Yiel,: ' _. (GPM) Test Type <br /> Total Depth of Boring 25 <br /> Test Length _..__. (Hours) Total Drawdown (Feet) <br /> Total Depth of Completed Well 25 Feet *May not be reI'e:er ative of a well's Ion term yield. <br /> I;_.; <br /> Casins _ Fill Annular Material <br /> P <br /> De th From Borehole Wall Outside ticreen Slot:ii ce Depth from Description <br /> Surface Diameter <br /> p Type Material Thickness Diameter Type if Ali r Surface r <br /> Feet to Feet Inches Inches Inches Inchu_ t to Feet <br /> Z Fee <br /> Attachments Certifi(alioll Statement <br /> ❑Geologic Log I,the undersigned,certify that this report is co-:i Dir to and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name All well Abandonment inc. <br /> 9 Person,Firm or CorpoSilot I I ar ch o Cordova CA 95742 <br /> ❑ Geophysical Log(s) 3369 Fitzgerald ROad f: --city state z;p <br /> ❑ SoiUWater Chemical Analyses Signed _ Atltls � 10/31/2014 848359 <br /> El Other Site Mag ce r efic __ Date Signed C-57 License Number <br /> Attach additional information if i—exists <br /> DWR 188 REV.1/2006 IF ADDITIONAL tPACE IS NEEDED.USE NEXT CONSECI I VE LY I JUMBERED FORM <br />