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'The free Adobe Reader may be used to view and complete this form However,software must be purchased to complete,save,and reuse a saved form. File Original with DWR State of California DWR Use Ont -Do Not Fill In Well Completion Report Page 2 Of 2 Refer to Instruction Pamphlet State Well Number/Site Number Owner's Well Number mw-8 No. e0338899 NI I I I I I w Date Work Began 04/13/2017 Dale Work Ended 4/17/2017 Latitude Longitude Local Permit Agency San.Inane tin Cout ty Environmental Health Department Permit Number 2901 Permit Date 4/12/17 APNrrRS/Other Geologic Log Well Owner Orientation OVertical 0Horizontal OAngle Specify Name Poul Franzia Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address 21801 E.highway 120 Depth from Surface Description Feet to Feet Describe material,grain size,color,etc City ESc010n StateC_1i 95320 49 52 SILTY SAND SM HEAVY OXIDATION LOTS Well Location OF ORGANICS Address 21801 F highway 120 52 53 POORLY GRADED SAND(SP)FINE-GRAINED, City Escolon County San Joaquin MODERATELY CEMENTED, HEAVYOXIDATION Latitude N Longitude _---ro 53 56 SANDY SILT(ML)LOW TO NO PLASTICITY DRY Deo Min se` Dec Min sec MODERATELY CEMENTED, FEW ORGANICS Datum Decimal Lal. Decimal Long. 56 60 POORLY GRADED SAND(SP)FINE-GRAINED, APN Book 205 Page 25 Parcel 016 MODERATELYCEMENTED,FEWORGANICS,Dpld Townshi Ra Section EMISSION 60 64 SILTYSAND(SM)FINE-GRAINEDSANDS, Location Sketch Activit MODERATELYCEMENTED,SLIGHTOXIDATION, - (Sketch must bedrawn b hand attertorrnns ted . New Well North O Modification/Repair FEW ORGANICS,WHITE STREAKS O Deepen 64 67 POORLY GRADED SAND(SP)FINE-GRAINED, O Other O Destroy DRY De rlbe procedures and mnen.l. 67 72 POORLY GRADED SAND(SP)FINE-GRAINED, orae deaOGlc Loo SLIGHT OXIDATION,MOIST Planned Uses 72 73 72-73 FT: FINE-GRAINED,WET O Water Supply C]Domestic El Public 73 79 MEDIUM-GRAINED, TRACE GRAVELS(<5%), ❑Irrigation ❑Industrial GRAVELS ARE PEBBLE SIZED,WET w O Cathodic Protection 79 84 79-84 FT: FINE-GRAINED, DAMP O Dewatering 84 86 84-86 FT: MEDIUM-GRAINED,TRACEGRAVELS O Heat Exchange (<5%),GRAVELS ARE PEBBLE SIZED, DAMP O Injection 86 88 86-88 FT: FINE-GRAINED,VERY SLIGHTLY 0 Monitoring CEMENTED, SLIGHT OXIDATION O Remediation 88 95 88-95 FT: LOOSE O Sparging 95 100 SILTY SANDY GRAVEL(GM)50-60%GRAVELS, South O Test Well 11-1,ate or oearnb.duhnce of—11 tom roam,bindings.I—. O Vapor Extraction GRAVELS ARE 1MM TO 4 INCHES THICK, mere etc and attach a mo .e p.U .ddluc_,paperitneo.sa.ry O Other (15%FINE-GRAINED), (10%MEDIUM-GRAINED rr...w.e.na..we (10-15%COARSE-GRAINED),VERY SLIGHT IFT411,91 Level and Yield of Completed Well OXIDATION,WET Depth to first water 68 (Feet below surface) Depth to Static Water Level 70 (Feet) Date Measured 04/21/2017 Total Depth of Boring 100 Feet Estimated Yield' 1 (GPM) Test Type Total Depth of Completed Well 98 Feet Test Length (Hours) Total Drawdown (Feet) 'May not be representative of a well's long term yield. Casings Annular Material Depth from Borehole Type Material wall Outside Screen Slot Size Depth from Surface Diameter Thickness Diameter Type If Any Surface Fill Description Feet to Feet Inches Inches Inches Inches Feet to Feet 0 68 110 Blank PVC Sch.40 4 61 Cement neat 68 98 110 Screen PVC Sch 40 Milled Slots 0.010 61 65 Bentonite Cetco Medium 65 98 Filter Pack #2112 Attachments Certification Statement El Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief El Well Construction Diagram Name Cascade Dry l l;na T p Person.Firm or Corporation CA 95776 ❑Geophysical Log(s) 2086 East Main Street Woodland ❑ Soil/Water Chemical Analyses Address City state zip ® Other map site Signed ? 1 0/-�o/17 938110 Attach additional information it it exists C-57 Licensed Water well Contractor Date Signed C-57 License Number DWR 188 REV 18006 IF ADDITIONAL SPACE IS NEEDED.USE NEXT CONSECUTIVELY NUMBERED FORM