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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 1 Of 1 Refer to Instruction Pamphlet State Well Number/Site Number Owner's Well Number WP0037596 No. XXXXXXX N I I I I IWI Date Work Began 11/15/2017 Date Work Ended 11/30/2017 Latitude Longitude Local Permit Agency San Joaauin County Permit Number WP0037596 Permit Date 11/15/17 APN/TRS/Other Geologic Log Well Owner Orientation O Vertical O Horizontal OAngle Specify Name Efren Castro Drilling Method Direct Rotary Drilling Fluid Fresh Water DMailing Address 1604 KVburz Ct Depth from Surface Description Feet to Feet Describe material,grain size,color,etc City Stockton State Ca Zi 0 7 Top Well Location 7 13 Sand Address 21455 Eastern Heights Rd 13 22 Clay City Linden County San Joaquin 22 45 sand Latitude N Longitude ---N 45 56 Fine Sand DeQ. Min. Sec. Dea. Min. Sec. 56 75 Sand Datum Dec.Lat. Dec.Long. 75 85 j Clay sand APN Book Page Parcel 85 92 Clay gravel Township Range Section 92 114 Clay Location Sketch Activit 114 118 Clay Gravel Sketch must be drawn North fter form is printed.) Q New Well 118 128 Sand O Modification/Repair O Deepen 128 132 Clay Sand O Other troy 132 168 Clay DOescri!G mcedures and materials 168 186 Sand _, under"GEOLOGIC LOG' 186 196 Sand Gravel R� E'lVF.L Planned Uses 196 208 Clay sand O Water Supply 208 226 Sand 2019 N MAR 2 9 N ❑� Domestic ❑Public C C l ❑Irrigation ❑Industrial 226 238 Clay Sand LU ENVIRONMENTAL HEALTH O Cathodic Protection 238 260 Sand Gravel PERMIT/SERVICES � Dewatering O Heat Exchange O Injection O Monitoring O Remediation O Sparging South O Test Well Illustrate ordescribe distance ofwell from roads,buildings,fences, O Vapor Extraction ri,em,etc.and attach a map.Use additional paper if necessary. O Other Please be accurate and complete. Water Level and Yield of Completed Well Depth to first water 120 (Feet below surface) Depth to Static Water Level (Feet) Date Measured Total Depth of Boring 260 Feet Estimated Yield* 30 (GPM) Test Type Total Depth of Completed Well 260 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 0 220 112 Blank PVC Sch.40 6 1 0 160 Bentonite Grout Well DF 220 260 12 Screen PVC Sch.40 6 10.032 160 260 Filter Pack Pea Gravel Attachments Certification Statement ❑ Geologic Log I,the undersigne p,certify that this report is complete and accurate to the best of my knowledge and belief EI Well Construction Diagram Name Castle th truction&Well Drilling ❑ Geophysical LO s Persq i, in r Corporation 9( ) 1418 J St i' � Modesto CA 95354 ❑ SoilMater Chemical Analyses � d r s City Stale zip ❑ Other y Signed 11 X - 11/30/2017 996768 Attach additional information if it exists. C- sed Water Well Contractor Date Signed C-57 License Number DWR 188 REV.1/2006 IF ADDITIONAL SRACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM