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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 II I I I Page 2 of 2 Refer to Instruction Pamphlet State Well Number/Site Number Owner's Well Number mw-9 No. e0355949 N W Date Work Began 04/11/2017 Date Work Ended 4/19/2017 Latitude Longitude Local Permit Agency San.Inapt lin County Fnvironmentel Health Department I I I I I I I I I 1_ I Permit Number 2901 Permit Date 4112/17 APN/TRS/Other Geologic Log Well Owner Orientation O Vertical O Horizontal OAngle Specify Name Poul franzia Drilling Method Hollow Stem Au er Drilling Fluid Mailing Address 21801 e. highway 120 Depth from Surface Description Escolon State �i 95320 Feet to Feet Describe material, rain size,color,etc Cit 40 42 POORLY GRADED SAND SP FINE-GRAINED Well Location DRY Address 21801 a highway 120 43 45 43.5-45 FT:MEDIUM-GRAINED,TRACE City Escolon County San Joaquin GRAVELS(<5%), GRAVELS ARE PEBBLE SIZEfJ Latitude N Longitude w (5-10%COARSE-GRAINED SANDS) Deo– Min Sec Deo Min sec 45 47 SILTY SAND(SM)MODERATELY CEMENTED, Datum Decimal Lat. Decimal Long. SLIGHT OXIDATION, DRY APN Book 205 Page 25 Parcel 016 47 48 POORLY GRADED SAND(SP)FINE-GRAINED, Townshi Range Section SLIGHT OXIDATION, DRY Location Sketch Activity 48 49 SILTY SAND(SM)HEAVY OXIDATION, FEW Sketch musIbedrawn b hand after form is printed. O' New Well North O Modification/Repair ORGANICS O Deepen 49 52 SANDY SILT(ML)LOW TO NO PLASTICITY, O Other WELL CEMENTED, FEW ORGANICS, DRY O Dp$lrDocedo,e dinatenalx 52 55 POORLY GRADED SAND(SP)FINE-GRAINED, under'GEGLOGIc LGG' SLIGHT OXIDATION, MOIST Planned Uses 55 59 57.5-59 FT: MEDIUM-GRAINED,TRACE O Water Supply [3 Domestic ❑Public GRAVELS(<5%), GRAVELS ARE PEBBLE SIZ _ ❑Irrigation [:]Industrial59 62 SILTY SAND(SM)FINE-GRAINED, (20-25%SIT w L O Cathodic Protection , FEW ORGANICS,WHITE STREAKS, DRY O Dewatering 62 71 SILTY SAND(SM)BRITTLE, SLIGHT O Heat Exchange OXIDATION, DRY O Injection 71 74 71 -73.5 FT:WET 0 Monitoring 74 76 SANDY SILT(ML)LOW PLASTICITY, SLIGHTLY O Remediation CEMENTED, SLIGHT OXIDATION, DAMP O Sparging 76 88 POORLY GRADED SAND(SP)FINE-GRAINED, South O Test well IYwtrate a decciibe d�Wc.a1 MY eom ro.da,buiWinq,knees, O Vapor Extraction DAMP rY—,etc.nd.n.ch.—p u—ci —ipito—tne ii—Y OOther 88 100 SANDY SILT(ML)TRACE GRAVEL(<5%), PI—.b.x-t.-d cpm late GRAVELS ARE PEBBLE SIZED,WELL CEMENT Water Level and Yield of Completed Well 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) *May 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 Fill Description Feet to Feet Inches Inches Inches Inches Feet to Feet Q 70 18 Blank PVC Sch.40 1 1 0 2 Cement 70 100 18 Screen PVC Sch.40 1 Milled Slots 0.010 2 6 Bentonite 6 63 Cement 63 100 Filter Pack #2112 Sand Attachments Certification Statement 0 Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief El Welt Construction Diagram Name Cascade Drilling LP Person.Firm or Corporation Woodland CA 95776 El Geophysical Log(s) 2086 East Main Street ❑SoiVWater Chemical Analyses Address _ City state zip ®Other man G i t-P Signed 10/30/17 938110 Attach additional information d it exists C-57 Licensed Water Weil Contractor Date Si ned C-57 License Number DWR 188 REV 1/2006 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM