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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 Page 2 0( 2 Refer to Instruction Pamphief State Well Number/Site Number Owner's Well Number MW-6D No. e0338899 r 1-I N i� I i I 1W� Date Work Began 04/13/2017 Date Work Ended 4/17/2017 Latitude �— Longitude .I Local Permit Agency San nanuin County Environmental Health Department I I I I I I I I I I I Permit Number 2901 Permit Date 4/12/17 APN/TRS/Other Geologic Log Well Owner Orientation (E)Vertical 0 Horizontal OAngle Specify Name Poul Franzia Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address 21801 E.highway 120 Depth from Surface Description Cit Escolon State CA �i 95320 Feel to Feet Describe material, rain size,color,etc 43 47 SANDY SILT ML HEAVY OXIDATION, FEW Well Location ORGANICS, SOFT Address 21801 E.hiahwav 120 47 52 POORLY GRADED SAND(SP)FINE-GRAINED, City Escolon County San Joaquin SLIGHT OXIDATION, DRY Latitude N Longitude �N 52 54 152-54FT:TRACE MEDIUM TO COARSE- Dea Min Sec Deo Min Sec GRAINED SANDS(<5%), SLIGHT OXIDATION Datum Decimal Lat. Decimal Long. 54 58 SILTYSAN D(SM)BRITTLE,HEAVY OXIDATION, APN Book 205 Page 25 Parcel 016 FEW ORGANICS, DRY Township Ran a Section 58 60 POORLY GRADED SAND(SP)FINE-GRAINED, Location Sketch Activity SLIGHT OXIDATION, DRY Sketch must bedrawn b hand after formrs nted Q New Well North Q Modification/Repair 60 64 60-64 FT: MEDIUM-GRAINED,TRACE COARSE O Deepen -GRAINED SANDS(<5%) O Other 64 73 WELL GRADED SAND(SW)TRACE GRAVELS O Destroy Daambe paceGurea an0 marenala (5-10%), GRAVELS ARE 1 M TO 1 INCH THICK Ana,'GEOLOGIC LOG' ANDSUBROUNDED,POORLYSORTED-GRAINEJJ Planned Uses SANDS(5%FINE-GRAINED), (25%MEDIUM- O Water Supply G [:]Domestic [:]Public RAINED), (60%COARSE ❑Irrigation ❑Industrial 73 77 WELL GRADED SAND(SW)TRACE GRAVELS Lu Q Cathodic Protection (5%), POORLY SORTED SANDS(35%FINE- Q Dewatering GRAINED),(30%MEDIUM-GRAINED), (30% Q Heat Exchange COARSE-GRAINED), DAMP WET O Injection 77 82 POORLYGRADEDSAND(SP)FINEGRAINED,WET 0 Monitoring 82 90 WELL GRADED SAND(SW)TRACE GRAVELS O Remediation (<5%),(25%FINE-GRAINED),(60%MEDIUM O Sparging GRAINED), (10%COARSE-GRAINED), DAMP south O Test Well 90 94 POORGRADEDSAND SP FINEGRAI NED,DAMP ;N.m.Ma rd.ftedn1e PJ' 9 diti—1 from O6°rifnpt' y Q Vapor Extraction D(SP) .M.and anach a map Use aEdNorul paper rineuaasry Q Other 94 98 POORGRADEDSAND(SP)FINE-GRAINED,DRY PNai°'K`"rn..nao 98 1100 SILTY SAND(SM)TRACE GRAVELS(<5%), Water Level and Yield of Completed Well GRAVELS ARE PEBBLE SIZED, SLIGHT Depth to first water 71 (Feet below surface) Depth to Static OXIDATION, SOFT, DAMP NOTES VERY STIFF 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 long term yield. Casings Annular Material Type Material Wall Outside Screen Slot Size Depth from Depth from Borehole Surface Diameter Thickness Diameter Type if Any Surface FIII Description Feet to Feet Inches Inches Inches Inches Feet to Feet 0 70 110 Blank PVC Sch.40 1 6 63 Cement neat 70 100 110 Screen PVC Sch 40 Milled Slots 10.010 63 67 Bentonite Cetco Medium 67 100 Filter Pack #2/12 Attachments Certification Statement D 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 Drilling LP Person❑ FurnorCoporaWoodland CA 95776 y Geophysical Log(s) 2086 East Main Street ❑Soil/Water Chemical Analyses Address /� city State zip ®Other Map site Signed _ 10/30/17 938110 Attach additional informaton a it emsts C-57 Licensed Water Well Contractor Date Signed C-57 License Number DWR 188 REV 1f1006 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM