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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 Only—Do Not Fill In Well Completion Report I 1 1 Page 1 Of 2 Refer to Instruction Pamphlet Owner's Well Number mw-9 No. e0338899 1 State WelNNumber/SiteNumber 1 I W Date Work Began 04/11/2017 Date Work Ended 4/19/2017 Latitude Longitude Local Permit Agency San_oaau n County Environmentel Health Department I I 11 11 1 I 1 I Permit Number 2901 Permit Date 4/12/17 APN/TRS/Other Geologic Log Well Owner Orientation O Vertical O Horizontal OAngle Specify Name Doul franzia Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address 21801 e. highway 120 Depth from Surface Description EsColon Ce 95320 Feet to Feet Describe material, rain size,color,etc Cit State_ZI 0 7 POORLY GRADED SAND SP WELL SORTED, Well Location FINE-GRAINED, TRACE SILT(<5%), DRY Address 21801 e. highway 120 7 8 7-7.5 FT: TRACE GRAVELS(<5%), GRAVELS City Escolon County San Joaquin ARE PEBBLE SIZED, DRY Latitude N Longitude �a 8 7.5- 10 FT: SLIGHTLY CEMENTED, HEAVY Deo Min Sec Deo Min sec OXIDATION,NO GRAVEL Datum Decimal Lat. Decimal Long. 13 11.5- 13 FT:MOIST APN Book 205 Page 25 Parcel 016 13 15 13- 14.5 FT:WELL CEMENTED, HEAVY Townshi Range Section OXIDATION,WHITE AND BLACK STREAKS Location Sketch Activit 15 17 SILTY SAND(SM)(75 80%FINE-GRAINED Sketch must Dedrawn D hand after formic nted New Well North SANDS),(15-20%SILT), MOIST O /Repair O Deepen 17 24 POORLY GRADED SAND(SP)MEDIUM- O Other O Destroy GRAINED,TRACE COARSE-GRAINED SANDS D 6bepr ed.r .M matenats (<5%), SLIGHTLY CEMENTED, DRY unde,'GEOLOGIC Lot" 24 25 23.5-25 FT:5-10%COARSE-GRAINED SANDS Planned Uses 25 27 SILTY SAND(SM)FINE-GRAINED SANDS, O Water Supply [:]Domestic ❑Public (10-15%SILT), SLIGHT OXIDATION y []irrigation ❑Industrial 27 29 POORLY GRADED SAND(SP)FINE-GRAINED, 3 w O Cathodic Protection TRACE SILT(5%), DRY O Dewatering 29 32 SILTY SAND(SM)FINE-GRAINED SANDS, O Heat Exchange (10-15%SILT), SLIGHT OXIDATION O Injection 32 34 SILTY SAND(SM)FINE-GRAINED SANDS, O Monitoring (10-15%SILT), SLIGHT OXIDATION O Remediation 34 37 POORLY GRADED SAND(SP)WELL SORTED, O Sparging FINE-GRAINED, DRY South O Test Well 37 39 SILTY SAND SM MODERATELY CEMENTED, =ate orde�crandnta—ofv 11fromroada.bwkin°e Nncea O vapor Extraction ( ) .etc and attach.map.Use adtlaional Pape,it--y O Other SLIGHT OXIDATION, DRY P ".it. C1R11eand` 39 40 39-40 FT:WELL CEMENTED, HEAVY Water Level and Yield of Completed Well OXIDATION Depth to first water 71 (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 100 Feet Test Length (Hours) Total Drawdown (Feet) Way not be representative of a well's long term yield. Casings Annular Material Depth from Borehole Wall Outside Screen Slot Size Depth from Surface Diameter Type Material Thickness Diameter Type if Any Surface FIII Description Feet to Feet Inches Inches Inches Inches Feet to Feet Q 70 18 Blank PVC Sch.40 1 1 Q 2 Cement 70 100 16 Screen PVC Sch.40 Milled Slots 0.010 2 6 Bentonite 6 63 Cement 63 100 Filter Pack #2/12 sand Attachments Certification Statement ❑Geologic Log I,the undersigned,c itifyDthgt this report is complete and accurate to the best of my knowledge and belief 13 Well Construction Diagram Name ascacle rilling, LP Person,Firm or Corporation Woodland CA 95776 El Geophysical LogMa Log(s) 2086 East Main Street ❑Soil/Water Chemical Analyses Address city s— Zip 10 Other map site Signed 10/30/17 938110 Attach additional Information.R It ewsts C-57 Licensed Water Well Contractor Date Signed C-57 License Number DWR 188 REV 12006 IF ADDITIONAL SPACE IS NEEDED.USE NEXT CONSECUTIVELY NUMBERED FORM