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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 1111111 ill i -T-� Refer to Instruction Pamphlet State Well Number/Site Number Owner's Well Number WP0036890 No. xxxxxxx NI I I I Iw Date Work Began 07/22/2017 Date Work Ended 7/25/2017 Latitude Longitude Local Permit Agency San Joaauin Permit Number WP0036890 Permit Date 7/20/17 APN/TRS/Other Geologic Log Well Owner Orientation O Vertical O Horizontal @Angle Specify Name Antonio Pacheco Drilling Method Direct Rotary Drilling Fluid Fresh Water Mailing Address 4625 Best Rd Depth from Surface Description Stockton ca Feet to Feet Describe material, rain size,color,etc Cit State 0 10 Top Soil Well Location 10 30 Soil Caly Address Same 30 60 Sand City County San Joaquin 60 120 Clay Latitude N Longitude _____yd 120 180 Sand Dec. Min. Sec. Dec. Min. Sec. 180 220 Clay Datum Dec.Lat. Dec.Long. 220 260 Sand APN Book Page Parcel 260 300 Coarse sand Township —Range Section Location Sketch Activity Sketch must be drawn by hand after form isrinted. Qi New Well North Q Modification/Repair O Deepen O Other Q Destroy Describe procedures and materials under'GEOLOGIC LOG" Planned Uses Q Water Supply ❑� Domestic ❑Public UJ ❑Irrigation ❑Industrial Q Cathodic Protection Q Dewatering Q Heat Exchange Q Injection Q Monitoring Q Remediation Q Sparging South Q Test Well Illustrate ordescribe distance ofwell from roads,buildings,fences, Q Vapor Extraction rivers,etc.and adech a map.Use additional paper if necessary. Q Other Please be accurate and complete. Water Level and Yield of Completed Well Depth to first water 90 (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 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 0 240 12 Screen PVC Sch.40 SDR 21 6 1 0 1110 Bentonite Grout well DF 240 300 12 Blank PVC Sch.40 SDR 21 6 110 300 Filter Pack Pea Gravel Attachments Certification Statement ❑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 Castle Construction&Well Drilling ❑ Geophysical Lo S Perso F' rCorporahon 9( ) 1001 S Iva uite A Modesto CA 95354 ❑ Soil/Water Chemical Analyses City State zip ❑ Other Signed 07/28/2017 996768 Attach additional information,if it exists. Licensed Water Well Contractor Date Signed C-57 License Number DWR 188 REV.1/2006 IF ADDITIONAL IePACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM