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State of California RECEIVED <br /> Well Completion Report <br /> Form DWR 188 Submitted 12/11/2019 <br /> WCR2019-017413 DEC 16 2019 <br /> Owner's Well Number 1 Date Work Began 11/01/2019 ENVIROR 44A4�M4/2019 <br /> Local Permit Agency San Joaquin County Environmental Health Department PERNIMSERVICES <br /> Secondary PenTO Agency Permit Number wp0039981 Permit Date 08/20/2019 <br /> Well Owner(must remain confidential pursuant to Water Code 13752) Planned Use and Activity <br /> Name DAVE BOERSMA Activity New Well <br /> Mailing Address 19012 S.CALLA DR <br /> Planned Use Water Supply Domestic <br /> City MANTECA State CA Zip 95336 <br /> Well Location <br /> Address 19012 S CALLA DR APN 228-030-048 <br /> City MANTECA Zip 95336 County San Joaquin Township 05S <br /> Latitude 37 28 17.8932 N Longitude -121 57 18.7199 W Range 01W <br /> Section 27 <br /> Deg. Min. Sec. Deg. Min. Sec. Baseline Meridian Mount Diablo <br /> Dec.Lat. 37.471637 Dec.Long. -121.9552 Ground Surface Elevation 55 <br /> Vertical Datum Horizontal Datum WGS84 Elevation Accuracy Unknown <br /> Location Accuracy Unknown Location Determination Method Other Elevation Determination Method Digital Aerial Photo <br /> Borehole Information Water Level and Yield of Completed Well <br /> Orientation Vertical Specify Depth to first water (Feet below surface) <br /> Drilling Method Direct Rotary Drilling Fluid Bentonite Depth to Static <br /> Water Level 48 (Feet) Date Measured 11/04/2019 <br /> Total Depth of Boring 300 Feet Estimated Yield' (GPM) Test Type Air Lift <br /> Test Length (Hours) Total Drawdown (feet) <br /> Total Depth of Completed Well 300 Feet 'May not be representative of a well's long term yield. <br /> Geologic Log -Free Form <br /> Depth from <br /> Surface Description <br /> Feet to Feet <br /> 0 3 TOP SOILL <br /> 3 37 SAND <br /> 37 62 CLAY <br /> 62 91 SAND <br /> 91 131 CLAY <br /> 131 152 SAND <br /> 152 167 SHALE <br /> 167 181 SAND <br /> 181 230 CLAY <br /> 230 237 SAND <br /> 237 264 CLAY <br /> 264 267 SAND <br /> 267 271 CLAY <br /> 271 276 SAND <br /> 276 280 CLAY <br /> Form DWR 188 rev. 12/19/2017 Page 1 of 2 <br />