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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 Well Completion Report Page of Refer to Instruction Pamphlet State Well Number/Site Number Owner's Well Number No. e0355639 N iI I I I IW Date Work Began 09/12/2017 Date Work Ended 9/21/2017 Latitude Longitude Local Permit Agency San Joaguin Health Dept, Permit Number 37172 Permit Date APN/TRSIOther Geologic Log Well Owner Orientation O Vertical O Horizontal OAngle Specify Name Marlene Coonce Drilling Method mud rota Drilling Fluid Bentonite mud Mailing Address P.O. Box 660 Depth from Surface Description Ripon CA 95366 Feet to Feet Describe material, rain size,color,etc Ci State_Zi 0 4 sand Well Location 4 6 hardpan Address 15127 French Camp Rd. 6 16 sand City Ripon County San Joaquin 16 28 clay Latitude N Longitude _yy 28 70 sand Den. Min. Sec. Den Min. Sec. 70 130 clay Datum Dec.Lat. Dec.Long. 130 147 sand APN Book 203 Page 110 Parcel 10 147 157 clay Township -Range Section 157 190 sand Location Sketch Activity 190 194 clay Sketch must be drawnha d after form is printed.) O New Well N 194 201 sand O Modification/Repair O Deepen 201 210 clay O Other 210 221 sand O Destroy Describe procedures and materials 221 235 fine sand with clay streaks under'GEOLOGIC LOG' 235 240 sand Planned Uses 240 256 clay O Water Supply 256 259 sand E]Domestic ❑Public 259 274 clay w ❑irrigation ❑industrial O Cathodic Protection 274 280 sand w/clay streaks O Dewatering O Heat Exchange O Injection O Monitoring O Remediation O Sparging South O Test Well Illustrate or describe distance of well from roads,buildings,lances, O Vapor Extraction rivers,etc,and attach a map.Use additional paper if necessary. O Other Phase be-rrie and oom late. Water Level and Yield of Completed Well Depth to first water (Feet below surface) Depth to Static Water Level 62 (Feet) Date Measured Total Depth of Boring 280 Feet Estimated Yield' (GPM) Test Type Total Depth of Completed Well 240 Feet Test Length (Hours) Total Drawdown (Feet) *May not be representative of a well's long term yield. Casings Annular Material Depth from Borehole T Material wall Outside Screen Slot Size Depth from Surface Diameter Type Thickness Diameter Type if Any Surface Fill Description Feet to Feet Inches Inches Inches Inches Feet to Feet 0 1200 14 Blank PVC .322 8 0 1108 1 quik grout 200 240 14 screen PVC .322 8 0.050 108 240 No 6 sand pack 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 Hennings Bros. Drilling Co-Inc. ❑ Geophysical Log(s) 1930 Laded RdFlm or Corporation Modesto CA 95356 ❑ Soil/Water Chemical Analyses _ Add r ss �, City state zip E] Other Signed , 10/23/2017 290813 Attach additional information if it exists. C57 qcensed Water Well C&tractor Date Signed C-57 License Number DWR 188 REV.112006 IF ADDITIONAL SPA6E IS NEEDED,USE NEXT CONSECUd&ELY NUMBERED FORM