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Page 1 of 1 Well Completion Report <br /> Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number 1 WP0038729 No. xxxxxxx I IN w <br /> Date Work Began 0Q/05/2018 Date Work Ended 09/12/2018 Latitude Longitude <br /> Local Permit Agency San Joa uin <br /> Permit Number WP0038729 Permit Date 08/30/2018 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation OVertical O Horizontal OAngle Specify Name Aravaln Harman <br /> Drilling Method Direct Rotary Drilling Fluid I Fresh Water Mailing Address 2Fi222 Mahnn Rd <br /> Depth from Surface Description <br /> Feet to Feet Describe material,grain size,color,etc city I Fsralon State Ca Zi <br /> 0 06 Top Soil Well Location <br /> 06 42 Sand Address Gama <br /> 42 48 Clav City I County San Joaquin <br /> 48 102 Sand Latitude N Longitude �N <br /> 102 124 Gravel Dea. Min. Sec. Dea. Min. Sec. <br /> 124 148 Sand Datum Dec.Lat. Dec.Long. <br /> 148 164 Small Gravel APN Book Page ParcelInRs-jin-77 <br /> 164 194 Sand Gravel Township -Ran a Section <br /> 194 226 Clav Location Sketch Activity <br /> 226 256 Sand Sketch must be drawn b hand after form is printed.) O New Well <br /> North O Modification/Repair <br /> 256 277 1 Sand Gravel O Deepen <br /> 277 300 Black Sand O Other <br /> Q Destroy <br /> Describe procedures and materials <br /> under"GEOLOGIC LOG' <br /> Ctiv Planned Uses <br /> t'L, O Water Supply <br /> �t 7 0 Domestic [:]Public <br /> '`f C g ���� M ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> pFRMIT SEAL tering <br /> RO E TH O HeatExchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> Illustrate ordescribe distance ofwell from roads,buildings,fences, <br /> O Vapor Extraction <br /> rivers,etc.and attach a map.Use additional paper if necessary. O Other <br /> Please be accurate and complete. <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 220 Feet Estimated Yield` (GPM) Test Type <br /> Total Depth of Completed Well 220 Feet Test Length (Hours)Total Drawdown (Feet) <br /> Way 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 Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 1280 15 Blank PVC Sch.80 SDR21 8 1 1220 Bentonite Grout well DF <br /> 280 300 15 Screen PVC Sch.80 SDR21 8 220 300 Filter Pack Grit Gravel <br /> Attachments Certification Statement <br /> ❑Geologic Log I,the updarsioned certify that this report is complete and accurate to th best of my knowledge and belie <br /> ❑Well Construction Diagram Name I Pnintc IuI r)rillinn <br /> -- i—nr rnrnnnatonn <br /> ❑Geophysical Log(s) Pn Rnx 1R2 . = IWP.,zt Pnint CA I Q5255 <br /> ❑Soil/Water Chemical Analyses iAddress city State Zip <br /> ❑Other Signed _ :�;; t. ..?. _ :' 09/30/2018 433493 <br /> Attach additional information if it exists. C-57 Licensed Water Well Contactor Date Signed C-57 License Number <br /> n1Am IRA Pr%/ 11)MA IC A-M-KIAI COAPC IC AIC-CI l I ICC LIC-rnKIO—I-1-1 V•II IR,-001I-ORA <br />