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'The tree Adobe Reader may be used to view and complete this form, However,software must be purchased to complete,save,and reuse a saved form, <br /> File Original with DWR State of Carifomia DWR Use Only—Do Not Fill In <br /> Page 1 of 1 Well Completion Report <br /> Rotor to lnsnactlon Pamphlet State Well NumberlSlte Number <br /> Owner's Well Number No, e0349984 N W <br /> Date Work Began 07/31/2017 Date Work Ended 81512_017 Latitude Longitude <br /> Local Permit Agency San JOaQUim Caurlfv Environ T]ental Health Deot. <br /> Permit Number S130077453 Permit Date 5111/17 APNITRS10ther <br /> Geologic Log Well Owner <br /> Orientation OVertical OHorizontal OAngle Specify Name Juan Grave <br /> Ddll!ng Method Mud Rotary Drilling Fluid water Mailing Address 2751 Shell Gate Circle <br /> Depth from Surface Description Hayward CA 94545 <br /> Feet to Feet Describe material rain size,color,etc Ci State_CA <br /> 0 3 Top Soil. Well Location <br /> 3 7 Clay Address 6257 W Linne Rd <br /> 7 10 Sand ` City Tracy County San Joaquin <br /> 10 16 ClayLatitude N Longitude <br /> 16 27 Black sand and gravel - coo. Mtn• sea Dec. Min. Sec. <br /> 27 53 Clay I Datum Dec.Lat. Dec.Long. <br /> 53 71 Clay PERi I ML tj APN Book 252 Page 090 Parcel 35 <br /> 71 75 Sand and gravel Township Range �_ Section_ _ <br /> 75 80 Clay with sand streaks Location Sketch M Activity <br /> 80 145 Clay Sketch muni ho drawn 6 hand atter form Is drtted. 0 New Well <br /> North O Modification/Repair <br /> 145 153 Sand with clay streaks O Deepen <br /> 153 180 Clay with sand streaks O Other <br /> oy <br /> 180 185 clay O DeoaSatte wocedura.wdm.a . <br /> 185 191 sand cr de'GEOLOGIC LOG' <br /> 191 200 -clay with sand streaks Planned Uses <br /> 200 207 clay ®Water Supply <br /> 207 , 217 gravel ]'Domestic ❑Public <br /> [Irrigation <br /> 220 Clay with sand streaks w thicn []industrialod <br /> O Cathodic Protection <br /> 220 233 Clay with sand streaks O Dewatering <br /> 233 242 sand and gravel O Heat Exchange <br /> 242 255 gravel with clay streaks O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> .._. ltusmoor oocafbodcsrin000fvtl em macs.buldhtas,terrcoa. O vapor Extraction <br /> rr+de, and attach a mop.U% eddaloaar paper t!necutaary, O Other <br /> Moa_bo oaa;ralaaM com lata. <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Leve] 38 (Feet) Date Measured <br /> Total Depth of Boring 255 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed well 255 Feet Test Length (Hours)Total Drawdown (Feet) <br /> way not be re resentalive of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Materia! Thickness Diameter Type If Any Surface 1`111 Description <br /> Feet n Feet Inches Inches Inches Inches Feet to Feet <br /> 0 235 114 Blank PVC .322 8 0 100 Bentonite Quik Grout <br /> 235 255 114 Perforated PVC .322 8 0.050 100 255 Filter pack No.6 Sand pack <br /> Attachments Certification Statement <br /> O Geologic Log I,the undersigned,certify that this report Is complete and accurate to the best of my knowledge and belief <br /> IJ Well Construction Diagram Name Hennings Bros Drilling Co Inc. <br /> PersonEl Geophysical Log(s) 1930 Ladd Rd� �drCarppreudn Modesto CA 95356 <br /> C3 SoiWWater Chemical Analyses ddro a City State Tp <br /> 13 Other Signed 08-16-17 290813 <br /> Attach addl!fonal information.If It axiate. 0.57 Licensed water Well Contractor a Date Signed C-57 License Number <br /> DWR 188 REV.112OW IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />