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Pa1 of 1 Well Completion Report <br /> Page Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number WP0037631 No. xxxxxxx N W <br /> Date Work Began F11/2R/2017 Date Work Ended 12/05/2017 Latitude Longitude <br /> Local Permit Agency FS-anioaauin I I I I I I I I I <br /> Permit Number WP0037631 Permit Date 11/22/2017 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specify Name lMirhqpl R Rama Frpnrh <br /> Drilling Method Direct Rota Drilling Fluid Fresh Water MailingAddress 4801 Micginn RdDepth from Surface Description <br /> Feet to Feet Describe material, rain size,color,etc city (�akdalP State Ca T gri3F7 <br /> 0 15 Top Soil Well Location <br /> 15 32 Sand Address9 37-.1 .larktnnn PH <br /> 32 56 Clav City Aramnn County San Joa uin <br /> 56 62 Sand Latitude N Longitude ----fv <br /> 62 82 Clav Dea. Min. Sec Dea Min. Sec <br /> 82 118 Sand Datum Dec.Lat. Dec. Long. <br /> 118 146 Clav APN Book Page Parcel10F15-1110-77 <br /> 146 163 Sand Township -Ran a Section <br /> 163 184 Clav Location Sketch Activity <br /> 184 204 Sand Sketch must be drawn b hand after form is printed Qi New Well <br /> North Q Modification/Repair <br /> 204 223 Clav O Deepen <br /> 223 244 Gravel O Other <br /> 244 263 Coarse Sand DesQ Destroy <br /> cnhe procedures and materials <br /> 263 276 Sand ■ at GEOLOGIC LOG' <br /> 276 300 Coarse Sand <br /> f � ��.tL untlPlanned Uses <br /> MAR 2 9 2019 @ Water Supply <br /> E L 7 [E]Domestic ❑Public <br /> Zi <br /> w ❑Irrigation ❑Industrial <br /> 3 ''NiROMMENTAL HEALTH Q Cathodic Protection <br /> -NNIMSEROCES O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> Q Vapor Extraction <br /> Illustrate or describe distance of well from roads,buildings,fences, O <br /> rivers,etc.and attach a map. Use additional paper if necessary Other <br /> Please be accurate and com tete. <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 300 Feet Estimated Yield' 0(GPM) Test Type <br /> Total Depth of Completed Well 300 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 /> 0 280 14 Blank PVC Sch.80 SDR21 8 1 1132 Bentonite Grout well DF <br /> 280 300 14 Screen PVC Sch.80 SDR21 8 132 300 Filter Pack Grit Gravel <br /> Attachments Certification Statement <br /> ❑ Geologic Log I,the undersigned,CQrtIfy that this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name Castle Co4trwction&Well Drilling <br /> ❑Geophysical Log(s) 1 nn 1 Modesto CA 95350 <br /> ❑ Soil/Water Chemical Analyses City State zip <br /> 11 Other Signed ► ! �--- 12/20/2017 996768 <br /> Attach additional information if it exists. C-57 Licet2 Water Well Contractor Date Signed C-57 License Number <br /> 11 AIA 10.A GF\/ 1Onin: -A--.— con/`c c—cncn 1.cc r..—rnnlccri I--v r.n nJo —Cn .1 <br />