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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. <br /> File Original with DWR State of California DWR Use Only-Do Not Fill In <br /> Page 1 of 1 Well Completion Report <br /> Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number SR0073875 No. xxxxxxx 1 1 1 1 N I I I I I w <br /> Date Work Began 01/10/2017 Date Work Ended 1/20/2017 Latitude Longitude <br /> Local Permit Agency San Joaauin County <br /> Permit Number SR007875 Permit Date 12/14/15 APNfrRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name Robert J Baker <br /> Drilling Method Direct Rotary Drilling Fluid Fresh Water <br /> Mailing Address 27189 E Vine Ave <br /> Depth from Surface Description <br /> Feet to Feet Describe material,grain size,color,etc City Escalon State ca Zi <br /> 0 7 Top Well Location <br /> 7 13 Sand Address Same <br /> 13 22 Clay City County San Joaquin <br /> 22 45 Sand Latitude N Longitude �N <br /> 45 56 Clay sand Deo. Min Sec. De% Min. Sec. <br /> 56 75 Sand Datum Dec. Lat. Dec.Long. <br /> 75 85 Clay Sand APN Book Page Parcel <br /> 85 92 Clay gravel Township -Range Section <br /> 92 114 Clay Location Sketch Activit <br /> Sketch must be drawn by had after form is printed.) O New Well <br /> 114 118 Clay Gravel <br /> O Modification/Repair <br /> 118 128 Clay Sand O Deepen <br /> 128 132 Clay O Other <br /> 132 144 Sand ClayO Destroy <br /> Describe procedures and materials <br /> 144 156 Sand under"GEOLOGICLOG' <br /> 156 166 Clay sand Planned Uses <br /> 166 170 Clay sand O Water Supply <br /> 170 178 Clay ❑� Domestic ❑Public <br /> 178 200 Sand w ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> 200 218 Clay O Dewatering <br /> 218 250 sand O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> Illustrate or describe distance of well from roads,buildings,fences, <br /> O Vapor Extraction <br /> fivers,etc.and attach a map,use additional paper if necessary. O Other <br /> Please be accurate and complete <br /> Water Level and Yield of Completed Well <br /> Depth to first water 80 (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 250 Feet Estimated Yield' 30 (GPM) Test Type <br /> Total Depth of Completed Well 250 Feet Test Length (Hours) Total Drawdown (Feet) <br /> *May not be representative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Type Material Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Yp Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 190 112 Blank PVC Sch.40 6 0 1108 Cement Grout Well DF <br /> 190 250 12 Screen PVC Sch.40 6 0.032 108 250 Filter Pack Pea Gravel <br /> Attachments Certification Statement <br /> ❑ Geologic Log I,the undersigned;certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑ Well Construction Diagram Name Castle Construction&Well Drilling <br /> ❑ Geo h SICaI LO S Person Fi r Corporation <br /> P Y g( ) 1418 J St Modesto CA 95354 <br /> ❑ Soil/Water Chemical Analyses sa city State zip <br /> ❑ Other Signed 01/22/2017 996768 <br /> Attach additional information if it exists. C-57 L ensed Water Well Contractor Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPA E IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />