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.The free Adobe Reader maybe used to view and complete this form. However,sef fare must be purchased to complete,save,arta reuse a saved form. <br /> File Original with DWR State of California DWR Jf#_6- -Do Notflll In <br /> Well Completion Report Tom , _! j- <br /> Page 1 O( 1 Refer tolnsWdlonPempnle} t� y -- <br /> St le 1 Number/S Number <br /> Owner's Well Number No. r t —L F <br /> Date Work Began 02/14/2017 Date Work Ended 2/16/2017 Ir L.�i Lattude - _ _ Longitude <br /> Can Loun,dn r^ � 1 i t <br /> Local Permit Agency County L_1�_ I . r <br /> Permit Number SR0076710 Permit Date 1/31117 APNlTRS/Other <br /> GeOo cLo- <br /> Orientation OVertical 0Horizontal OAngle Specify <br /> Drlling Method Direct Rotary Drilling Fiuid Fresh Water <br /> vepth from urfaae I)escrlptlon <br /> Feet to Feet Aescdl?a.'inaterlal gralo size trolor etc <br /> 0 10 Top Soil _ Well1,0Callon <br /> 10 18 Sand _ Address Same <br /> 18 36 Sand/Cl ay — city County San Joaquin <br /> 36 55 Clay _ _ _ Latitude N Longitude <br /> 55 68 Sand Dec M n S•c. Oeo. M{n. Sec. <br /> 68 75 Sand/Clay Datum Dec.Lat. Dec.Long. <br /> 75 98 Sand APN Book Page Parcel <br /> 118 Clay Tovmshi Ran a —= Section <br /> 98 <br /> 98 150 ClaySanlay Loeation Sketch Activit <br /> ketah, st be drawn hand atter tato is - •nted.. New Wet1 <br /> 150 170 Clay _ North 0 ModiticatloNRepair <br /> 170 175 Sand/Clay O Deepen <br /> 175 200 Clay/GravelO Other <br /> — <br /> 0 Destroy <br /> o..ua»po�m...�e nwl.rwa <br /> unMr'GEOIOOIG LOG' <br /> pldnne 'Uses <br /> 0 Water Supply <br /> E]Domeslic ❑Public <br /> ❑Irrigation ❑Industrial <br /> w <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remedlation <br /> O Sparging <br /> O Test Well <br /> South Q Vapor Extraction <br /> J M•H.a aeau�a eeun:.w.ee no rwa.,bul*r p I 0 Other <br /> rhwa,ai<..nJ aceta.m aP-lie a Gh'.bnal paP.r N ntcnaary. <br /> Ptaas.W.aaunlo�•Complete. <br /> Water Gavel and Yield of Com leted Well <br /> Depth to first water 50 (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 200 Feet Estlmated Yield' 3_(GPM) lost Type <br /> Total Depth of Completed Well 200 Feet <br /> Test Length (Hours) Total Drawdown (Feet) <br /> -may not be representative of a well's long term vield. <br /> Casio s Annular Mater a <br /> Depth from Boreholo Type Material Wall Outalde Screen Slot Size Depth from FIIt <br /> Surface Diameter DescripUon <br /> TThickness Diameter Type if Any Surface <br /> _ Inches Inches _ Inches Inches Feet to Feet <br /> Feet f Feet <br /> 0 0 113 Bentonite Grout Well DF <br /> 140 12 Blank PVC Sch.40 6 <br /> 140 200 12 Screen PVC Sch.40 6 <br /> 0.032 113 200 Firer Pack Pea Gravel <br /> aohrn f - CerWC6tion StatBtnent <br /> O Geologic Log 1,the undersigns a 'ly that this report is complete and accurate <br /> knowledge and belief <br /> to the best of my <br /> Name In o t ti ell Driliin <br /> ❑Well Construction Diagram Pere Fh or opomuwCA 95354 <br /> ❑Geophysical Logs) 1 Modesto cry State Zip <br /> ElSoil/Water Chemical Analyses - re <br /> Signed 0211612017 996768 <br /> El Other C-5 L n e water Well Date Signed C-57 License Number <br /> Aaerh addlu-01 addle-01IM ntion K it exists- <br /> DWR 180 REV.10006 IF ADC 1T-1011 <br /> S E IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />