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Well Completion Report Page 1 of 1 Refer to Instruction Pamphlet State Well Number/Site Number Owner's Well Number WP0037977 i No. xxxxxxx I I I I INI IW Date Work Began 09/psonl R Date Work Ended 03/12/2018 Latitude Longitude Local Permit Agency San Joa uin Permit Number 1 WP0037977 Permit Date 02/23/2018 APNITRS/Other Geologic Log Well Owner Orientation O Vertical O Horizontal OAngle Specify Name I Aarnn Al irtman Drilling Method Direct Rota I Drilling Fluid Fresh Water Mailing Address 9R777 nwanc Rd Depth from Surface Description Feet to Feet Describe material,grain size,color,etc city I Fscalnn J State—C—a--Zip 0 07 TOP Soil Well Location 07 22 Brown Clav Address --.M. 22 31 Sand City County San Joaquin 31 42 Fine Sand Latitude N Longitude _yV 42 46 Coarse Sand Dec. Min. Sec. Dea. Min. Sec. 46 62 Brown Clav Datum Dec.Lat. Dec.Long. 62 70 Clav APN Book Page Parcel1nR-t;-11Q-77 70 92 Coarse Sand -Township Ran a Section 92 112 Fine Sand Location Sketch Activity 112 129 Clay Sketch must be drawn b hand after form is printed-) O New Well North O Modification/Repair 129 143 Sand O Deepen 143 164 Coarse Sand O Other 164 182 Sand O Destroy Describe pmcedures and materials 182 194 Clay under'GEOLOGIC LOG' 194 222 Sand �� Planned Uses ��ED 222 236 Coarse Sand O Water Supply 236 254 Coase Sand Fine Sand Z5 p Domestic [:]Public MAR Z g 2019 W ❑Irrigation ❑Industrial O Cathodic Protection ENVIRONMENTAL HEALTH O Dewatering PERMIT/SEWES O Heat Exchange 0Injection O Monitoring O Remediation O Sparging South O Test Well Illustrate or describe distance ofwell from mads,buildings,fences, O Vapor Extraction rivers,etc.and attach a map.Use additional Paper if necessary. O Other Please be accurate and complete, Water Level and Yield of Completed Well Depth to first water I (Feet below surface) Depth to Static Water Level (Feet) Date Measured Total Depth of Boring 1254 Feet Estimated Yield* F------7(GPM) Test Type Total Depth of Completed Well 254 Feet Test Length (Hours) Total Drawdown (Feet) *May not be representative of a well's long term yield. Casings Annular Material Depth from Borehole T e Material Wall Outside screen Slot Size Depth from Surface Diameter yp Thickness Diameter Type if Any Surface Fill Description Feet to Feet Inches Inches Inches Inches Feet to Feet 0 1234 12 1 Blank PVC Sch.80 SDR21 6 1 120 Bentonite Grout well DF 234 254 12 Screen PVC Sch.80 SDR21 6 120 254 Filter Pack Grit Gravel AI I I Attachments Certification Statement ❑Geologic Log I,the undersigned,cEfrtify that this report is complete and accurate to the best of my knowledge and belief ❑Well Construction Diagram Name Castle Construction&Well Drilling ❑Geophysical Log(s) ono Rvlvan Avr?StP ---Modesto CA 95350 �^ City State Zip ❑Othater Chemical Analyses Signed w �6 04/02/2018 996768 Attach additional information rf iC t exists. secl ++ Water Well Contractor Date Signed C-57 License Number nIMJ 1AA Or=\/ 1I7MC\ IC nnnlTln.lnl COn/`C F uCcnCn I ICC I.rC VT!`l1nICCr`I ITI\/CI V SII 1�lOC OCn CnO�A i_.