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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 SR0077381 No. xxxxxxx N W Date Work Began 05/18/2017 Date Work Ended 5/25/2017 Latitude Longitude Local Permit Agency San Joaauin County Permit Number SR0077381 Permit Date 5/4/17 APN/TRS/Other Geologic Log Well Owner Orientation O Vertical O Horizontal OAngle Specify Name Fernando Herrera Drilling Method Direct Rotary Drilling Fluid Fresh Water Mailing Address 8362 S Wolfe Rd Depth from Surface Description Feet to Feet Describe material,grain size,color,etc City French Camp State Ca Zi 0 7 Top Well Location 7 13 Sand Address Same 13 22 Clay City County San Joaquin 22 45 sand Latitude N Longitude ____N 45 56 Clay sand Deq. Min. Sec. Deo. Min. Sec. 56 75 Sand Datum Dec.Lat. Dec.Long. 75 85 Clay sand APN Book Page Parcel 85 92 Clay gravel 1 Township -Range Section 92 108 Clay Location Sketch Activit 108 114 Clay Gravel Sketch must be drawn by hand after form is rinted. 0 New Well North 114 128 Clay Sand O Modification/Repair O Deepen 128 132 Clay O Other 132 144 Sand Clay O DDesscrbeeprocedures and materials 144 156 Sand un "GEOLOGIC LOG' 156 166 Clay sand ";, ,,'„ Planned Uses 166 170 Clay sand fl -- O Water Supply Domestic ❑Public 170 178 Clay 178 200 Sand ,f� _ t w ❑Irrigation ❑Industrial O Cathodic Protection BVIKOKIMd t r t O Dewatering rAli Heat Exchange v O 1 njection O Monitoring O Remediation Sparging South O Test Well Illuslrala or describe distance of well from roads,buildings,fences, O Vapor Extraction rNers,etc.and attach a map.Use additional paper if necessary. O Other Please be accurate and camIete. Water Level and Yield of Completed Well Depth to first water 80 (Feet below surface) Depth to Static Water Level (Feet) Date Measured Total Depth of Boring 200 Feet Estimated Yield' 30 (GPM) Test Type Total Depth of Completed Well 200 Feet Test Length (Hours)Total Drawdown (Feet) *May not be representative of a well's long term yield. Casings Annular Material Depth from Borehole Type 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 0 160 112 Blank PVC Sch.40 6 1 0 1102 Bentonite Grout Well DF 160 200 12 Screen PVC Sch.40 6 10.032 102 1200 Filter Pack Pea Gravel Attachments Certification Statement ❑ Geologic Log I,the undersigned,ce�rrttify that this report is complete and accurate to the best of my knowledge and belief ❑ Well Construction Diagram Name Castle Consittr ction&Well Drilling Person,Fi oration 11 Geophysical LO S 1418 J St ModestoCA 95354 ElSoil/Water Chemical Analyses a Cry stale Zip ❑Other Signed k - 05/25/2017 996768 Attach additional information if it exists. C-57 Lice sed alar WEII Contractor Date Signed C-57 License Number DWR 188 REV.1/2006 IF ADDITIONAL SPACE W NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM