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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 Page 1 of 1 Well Completion Report Refer to Instruction Pamphlet State Well Number/Site Number Owner's Well Number WP0036917 No. xxxxxxx I I I N I I I I I w Date Work Began 08/02/2017 Date Work Ended 8/6/2017 Latitude Longitude Local Permit Agency San Joaauin Permit Number WP0036917 Permit Date 7/26/17 APN/TRS/Other Geologic Log Well Owner Orientation OVertical O Horizontal OAngie Specify Name Juan Manuel Gudino Drilling Method Direct Rotary Drilling Fluid Fresh Water Mailing Address 5323 E Carpenter Rd Depth from Surface Description Feet to Feet Describe material,grain size color,etc City Stockton State ca Zi 0 110 -Top Soil Well Location 10 45 Sand Address Same 45 60 Coarse sand City County San Joaquin 60 80 Clay Latitude N Longitude w 80 96 Sand Deq. Min. Sec. Dea. Min. Sec. 96 120 Clay Datum Dec.Lat. Dec.Long. 120 160 Sand APN Book Page Parcel 160 180 Clay 1 Township Ran e Section 180 240 sand Location Sketch Activity 240 260 Clay Sketch must be drawn b hand after form is printed.) Q New Well 260 300 Sand North Q Modification/Repair O Deepen O Other Q Destroy Describe procedures and materials under'GEOLOGIC LOG' Planned Uses Water Supply ODomestic []Public to []irrigation [Industrial Q Cathodic Protection Q Dewatering Q Heat Exchange Q Injection Q Monitoring Q Remediation Q Sparging South Q Test Well Illustrate or describe distance of well from roads,buildings,fences, O Vapor Extraction rivers,etc.and attach a map.Use additional paper if necessary. Q Other Please be accurate end cpm Iete. Water Level and Yield of Completed Well Depth to first water 85 (Feet below surface) Depth to Static Water Level (Feet) Date Measured Total Depth of Boring 300 Feet Estimated Yield* (GPM) Test Type Total Depth of Completed Well 300 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 0 240 12 Screen PVC Sch.40 SDR 21 6 0 110 Bentonite Grout well DF 240 300 12 Blank PVC Sch.40 SDR 21 6 110 300 Filter Pack Pea Gravel I Attachments Certification Statement ❑ Geologic Log I,the undersigned ce ify that this report is complete and accurate to the best of my knowledge and belief ❑ Well Construction Diagram Name Castle C u tion&Well Drilling Person, i rporation ❑ Geophysical Log(s) 1001 SvIvarm o A Modesto CA 95354 ❑ Soil/Water Chemical Analyses - City State zip ❑ Other Signed 08/10/2017 996768 Attach additional information,if it exists. C-57 nsed Water Well Contractor Date Signed C-57 License Number DWR 188 REV.1/2006 IF ADDITIONAL SPA E IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM