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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 I l Page 1 Of 2 Refer to Instruction Pamphlet State Well Number/Site Number Owner's Well Number MW-6D No. e0338899 N w Date Work Began 04/13/2017 Date Work Ended 4/17/2017 Latitude Longitude Local Permit Agency San Joaauin County Environmental Health Department I l I I I I I Permit Number 2901 Permit Date 4/12/17 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.hiahway 120 Depth from Surface Description Cit ESCDIOn State CA �i 95320 Feet to Feet Describe material, rain size,color,etc 0 9 SILTY SAND SM 15-20%SILT), 80-85%FINE- Well Location GRAINED SANDS), POORLY GRADED SANDS, Address 21801 E.highway 120 9 11 SANDYSILT(ML)NOPLASTICITY,TRACE FINETO Coy Escolon County San Joaquin MEDIUM-GRAINEDSANDS,BLACKSTREAKS, Latitude N Longitude ____/v HARD. DRY Dea Min. Sec Deo Min Sec 11 14 POORLY GRADED SAND(SP)SLIGHT Datum Decimal Lat. Decimal Long. OXIDATION, DRY APN Book 205 Page 25 Parcel 016 14 17 SANDY SILT(ML)TRACE FINE TO MEDIUM, Township Ran Section GRAINED SANDS(<5%),SLIGHT OXIDATION, Location Sketch Activity SOFT, DRY Sketch must be drawn D hand after form is Med Qi New Well North 0 Modification/Repair 17 19 POORLY GRADED SAND(SP)FINE-GRAINED O Deepen MEDIUM-GRAINED FINE-GRAINED O Other 19 24 SANDY SILT(ML)NO PLASTICITY,SLIGHT O Destroy DescdDa procedures end metaiels OXIDATION, FEW BLACK STREAKS, SOFT, DRY nder�,eorooicLoc- 24 27 SANDY SILT(ML)NO PLASTICITY,SLIGHT Planned Uses OXIDATION, FEW ORGANICS,SOFT, DRY fMQE1y ,e ' O Water Supply f4Y � [:]Domestic ❑Public 27 34 POORLY GRADED SAND(SP)FINE-GRAINED, AA 11� [Irrigation [IndustrialROUNDED GRAINS, SLIGHT OXIDATION 3 A� b � � w0 Cathodic Protection 34 37 SANDY SILT(ML)TRACE FINE-GRAINED O Dewatering SANDS(<5%), HEAVY OXIDATION,SOFT, DRY eVMONMENTALHEAL O Heat Exchange 37 39 SILTY SAND(SM)FINE TO MEDIUM-GRAINED, PERMir/SERU,H �'' O Injection FEW ORGANICS, BRITTLE, DRY O' Monitoring 39 40 39-40 FT: (10%FINE-GRAINED SANDS), O Remediation (15%SILT), (75%MEDIUM-GRAINED SANDS), O Sparging FEW ORGANICS, BRITTLE, DRY South O Test Well 40 42 SILT(ML)LOTS OF ORGANICS,STIFF,BRITTLE, xWetrnte add.U. O..p,u...domweds,Duildinys.renccs. O vapor Extraction rvers,etc.and Nbch■map.Use eddabrtl paper it necessary O Other DRY pkase treeccuMeend tele 42 43 POORLY GRADED SAND(SP)FINE-GRAINED, Water Level and Yield of Completed Well SLIGHT OXIDATION, DRY Depth to first water 71 (Feet below surface) Depth to Static Water Level 71 (Feet) Date Measured 04/24/2017 Total Depth of Boring 100 Feet Estimated Yield' 2 (GPM) Test Type Total Depth of Completed Well 100 Feet Test Length (Hours) Total Drawdown (Feet) *May not be representative of a well's Iona term vield. 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 0 70 10 Blank PVC Sch.40 6 63 Cement neat 70 100 10 screen PVC Sch.40 Milled Slots 0.010 63 67 Bentonite Cetco Medium 67 100 Filter Pack 42/12 Attachments Certification Statement ❑� Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief ❑Well Construction Diagram Name Cascade Dr;l l;na T,P ❑Geophysical Log(s) 2086 KTft" 9Yi?rDTTeet Woodland CA 95776 ❑ Soil/Water Chemical Analyses Address � Q k City Stet. Zrp ® Other map site Signed 10/30/17 938110 Attach addeonal Information A it exists C-57 Licensed water well Contractor Date Signed C-57 License Number DVVR 188 REV V2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM Cascade Job# 131-17-1019