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'The free Adobe Reader may be used to view and complete\1rorm. However,software must be pu•chased to comp!n e, :av;`�reuse a saved form. <br /> File Original with DWR State of California DWR Use Only-Do Not Fill In <br /> Well Completion Report C-. I ;-(,r��� <br /> Page 1 Of 1 Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number MW-6 No. e0239308 [1 ! I N I II I I 1W <br /> Date Work Began 08/25/2014 Date Work Ended 9/4/2014 _ _. Latitude Longitude <br /> Local Permit A enc in County Environmental Health Department [�_ <br /> Agency can.!r+ant!! .- <br /> Permit Number 070177 Permit Date 6/30/14 „__• APN/TRS/Other <br /> Geologic Lo Well Owner <br /> Orientation ❑Vertical ❑Horizontal OAngle Specify Name San Joag,ln _punts <br /> Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address I:' 3o c 1810 <br /> Depth from Surface Description Stockton CA �i 95201 <br /> Feet to Feet Describe material, rain size,color,etc Cit'/ C= State <br /> 75 0 Overdrill 2" Well Location <br /> Address 2662 I\ Vbiscn Way <br /> City Stockton ,•__. County San Joaquin <br /> Latitude N Longitude �N <br /> Deo. M n. Sec. Deq. Min. Sec. <br /> Datum DEC.Lat. 37.982848 Dec.Long.-121.271673 <br /> APN Book 117 ,•_ Ptlge 060 Parcel 33 <br /> TONnship _R_e 1 e Section <br /> Loci oI i IS ketch Activit <br /> 7iketch must be drat.:by han i after form is rimed. O New Well <br /> Nc rth O Modification/Repair <br /> O Deepen <br /> O Other <br /> Q Destroy <br /> Describe procedures and materials <br /> under'GEOLOGIC LOG <br /> Planned Uses <br /> Q Water Supply <br /> []Domestic O Public <br /> 'g; w Olrrigation Olndustrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> Monitoring <br /> O Remediation <br /> O Sparging <br /> O Test Well <br /> S tut <br /> Vapor Extraction <br /> Illuttrate or rm roads,buildings, <br /> lencea, <br /> rivers,etc.and attach a me:.Us,adl tional paper it necessary. O Other <br /> Ple sse be accurate and c:r Pk:ems <br /> ater Level aFlEl field 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 75 Feet E:5timated Yield ' __._(GPM) Test Type <br /> Test Length _..__. (Hours) Total Drawdown (Feet) <br /> Total Depth of Completed Well 75 Feet 'May not be rept!;se itE .ive of a well's long term yield. <br /> Casings _ Annular Material <br /> Depth from BoreholeType Material wall Outside Screen Slot SV. :-epth from <br /> Thickness <br /> Surface Diameter Diameter Type if An) Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inchez,_ Fret to Feet <br /> Attachments Certific :ic n Btatement <br /> ❑Geologic Log I,the undersigned,certify that this report is comm I ttE and accurate to the best of my knowledge and belief <br /> O Well Construction Diagram Name All well Abandonment i ic. <br /> g Person,Firm or corporation <br /> O Geophysical Log(s) 3369 Fitzgerald Road.Suite 3ordova CA 95742 <br /> O Sol/Water Chemical Analyses Address, _!r'�Li,-.' "r,t' City State Zip <br /> D Other Site Mar) Signed I _ _ 10/31/2014 848359 <br /> Attach additional informationit it exists. a er ractor _ Date Signed C-57 License Number <br /> DWR 188 REV.1/2008 IF AdDITIONAL SPACE IS NEEDED.USE NEXT CONSECUTI'-:LY NLIASERED FORM <br />