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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. <br /> File Original with DWR State of California DM Use —Do Not Fill In <br /> Well Completion Report <br /> Page 1 of 1 Reter to Instruction Pamphlet State WeII Number/She Number <br /> Owner's Well Number SR0075995 No. xxxxxxx <br /> Date Work Began 10/17/2016 Date Work Ended 10/24/2016 Latitude Lon itude <br /> Local Permit Agency San uloaauin County <br /> Permit Number SR0075995 Permit Date 8/12/16 APN(TRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specht' Name Eugenio Garcia <br /> Drilling Method Direct Rotary Drilling Fluid Fresh Water Mailing Address 571 N Alpine Rd <br /> Depth from Surface Description Stockton ca <br /> Feet to Feet Describe material, rain size color,etc Ci on State_� <br /> sci <br /> 0 10 Top Soil Well Loml>on <br /> 10 90 Sand Address Same <br /> 90 110 Small Gravel City Count' San Joaquin <br /> 110 125 Clay Latitude ___ N Longitude—57—_ W <br /> 125 140 Sand DEC. Min. Se . Ow. MIn. sec. <br /> 140 260 Clay Gravel Datum Dec.Lat. Dec.Long. <br /> APIA Book Page Parcel <br /> Township —Range Section <br /> Location Sketch Activity <br /> sketch must be dirman by hand after foam is anted. Q. New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> - O Destroy <br /> Describe procedures and materials <br /> under'GEOLOGIC LOG' <br /> Planned Uses <br /> 0 Water Supply <br /> El Domestic El Public <br /> ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Spangling <br /> South O Test Well <br /> d-seate ar deaerroe distance orwell from mad�.bwenna,rent 0Vapor Extraction <br /> er <br /> des,em.and amen s o., so aaauions <br /> i paper uneaeaaary�a. O Other <br /> please be accurate and complete <br /> ater Level and Yield of Completed Well <br /> Depth to first water 85 (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 260 Feet Estimated Yield a 30 (GPM) Test Type <br /> Test Length (Hours) Total Drawdown_(Feet) <br /> Total Depth of Completed Well 260 Feet *Manot be re resentative of a well's long term yield, <br /> Casin s Annular Material <br /> Depth from Borehole Type Material Wall Outside Screen Slot Size Depth from <br /> Surface Dlarrretar yp ThlTnless Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet m Feet <br /> 0 200 12 Blank. PVC Son.40 6 0 115 Bentonite Grout Well DF <br /> 200 260 12 Screen PVC Sch.40 6 0.032 115 260 Filter Pack Pea Gravel <br /> Attachments Certitleatlon Statemeht <br /> ❑Geologic Log I,the undersign rtify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name Castle U ion&Well Drillin <br /> Person, or ration CA 95354 <br /> ❑ Geophysical Logs) 1418 J St Modesto <br /> ❑ Soil/Water Chemical Analyses ress cuty state zip <br /> ❑ Other Signed 10/26/2016 996768 <br /> Attadi additional lMormaron n n losfs, <br /> csT writ well nvaCor Date Si red C-57 License Number <br /> DWR 18a REV.112008 IF ADDITIONAL SPACE EEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />