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'The free Adobe Reader maybe 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 On —Do Not Fill In Well Completion Report Page 1 of 1 Refer to rnvructlon Pamphlet State Well Number/Site Number Owners Well Number 1 No. e0338520 I I I N W Date Work Began 02/21/2017 Date Work Ended 3/28/2017 Latitude Lon nude Local Permit Agency San.loanuin C nvnty Environmental Health Dept __ Permit Number SR0075693 Permit Date 9/6/16 APN/TRS/Other Geologic Log Well Owner Orientation O Vertical O Horizontal OAngle specify Name Rosa Farms LLC C/o Grant Van Duvn Drilling Method Reverse Rotary Drilling Fluid Water Mailing Address 12100 Graves Rd Depth from Surface Description Feet to Feet Describe material,grain sae,color,etc City Manteca State CA Zi 95336 0 11 Op Soil Well Location 1 122 Sand Address 12501 Graves Rd 22 140 Clay with sand streaks City Manteca County San Joaquin 40 145 Sand Latitude N Longitude 45 160 Clay with sand streaks Dea. Min Sec, Deo Min Seo. 60 169 Sand Datum Dec. Lat. Dec. Long. 69 185 Clay with sand streaks APN Book 228 Page 070 Parcel 03 85 1110 Clay Township Rance Section 110 1115 - Sand -- Location Sketch Activit 115 122 Sand with clay streaks Sketch masts be drawn la had after form is nted. pNew Well 122 128 Clay orth O Modification/Repair O Deepen 128 142 Sand with clay streaks O Other 142 170 Clay with sand streaks Q Destroy 0eeaee em eaums em me,enen 170 200 Clay umer'GEOLCGICLGG' 200 210 Sand Planned Uses 210 228 Clay O Water Supply ❑Domestic ❑Public 228 252 Sand with clay streaks y 252 265 Clay3 w ❑Irrigation ❑Industrial 265 260 Sand O Cathodic Protection O Dewatering 280 295 Clay Q Heat Exchange 295 330 Sand 0Injection 330 344 Clay O Monitoring 344 350 Sand O Remediation 350 1370 Clay O Sparging 370 392 Clay with sand streaks South O Test Well nmsvme waesmce al:,°nceel.,einran roaa:,wiwmas,races, O Vapor Extraction 392 418 Clay ,�,em.,na enememeo. uee eaanm�elwcern�eceeeen. O Other 418 437 Sand 475-488 Clay 437 451 Clay 488-500 Sand Water Level and Yield of Completed Well 451 470 Sand Depth to first water (Feet below surface) Depth to Static 470 1475 Clay with sand streaks Water Level 36 (Feet) Date Measured Total Depth of Boring 500 Feet Estimated Yield' 1,628 (GPM) Test Type Total Depth'of completed Well 470 Feet Test Length (Hours) Total Drawdown (Feet) 'Ma not be repre of a well's loo term ield. 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 Fast to Fast Inches Inches Inches Inches Feet to Feet 0 150 136 1 Conductor I Mild steel .025 30 1 1 0 150 Cement 10.3 Sack 0 260 126 1 Blank I Mild Steel .025 16 11 0 470 Filter pack No.6 sand pack 260 350 26 Full Flo Mild Steel .025 16 10.090 350 410 26 Modified Mild Steel .025 16 0.090 410 470 26 Ful-Flip Mild steel .025 16 0.090 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 Ladd Rd Fimacorpomlon M esto CA 95356 ❑ Soil/Water Chemical Analyses ddress city stele zip ❑ Other Signed 03-31-2017 290813 Anech addilanal irttr ion d it exists. C5 LLicensed Water Well contra or Date Signed C-57 License Number DWR 189 REV.12006 IF ADDmONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELI NUMBERED FORM