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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. <br /> File Original with DWR State of California DWR Use Only–Do Not Fill In <br /> Page 1 of 1 Well Completion Report <br /> Refer to Instrudmn PamG;hjel State Well Number/Site Number <br /> Owner's Well Number No. xxxxxxx N l rTT i <br /> Date Work Began 05/01/2017 Date Work Ended 517/2017 Latitude Longitude <br /> Local Permit Agency San Joaauin County I I I I I I I I I I I <br /> Permit Number SR0077308 Permit Date 4/26/17 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name Carole Sletton <br /> Drilling Method Direct Rotary Drilling Fluid Fresh Water <br /> Mailing Address 28513 Lemon Ave <br /> Depth from Surface Description <br /> Feet to Feet Describe material,grain size,color,etc City eScalon Slate Ca 7i <br /> 0 7 .-Top Well Location <br /> 7 25 Sand Address Same <br /> 25 33 Coarse sand City County San Joaquin <br /> 33 40 Clay sand _ Latitude N Longitude _yv <br /> 40 46 sand Deo Min. Sec. Deo. Min Sec <br /> 46 50 Clay Datum Dec.Lat. Dec.Long. <br /> 50 54 Sand APN Book Page Parcel <br /> 54 62 Clay Township -Range Section <br /> 62 66 Sand Location Sketch Activity <br /> Sketch must be drawn b hand after form Is anted. Q New Well <br /> 66 76 Clay North O Modification/Repair <br /> 76 80 Sand/Clay O Deepen <br /> 80 82 Clay/Gravel O Other <br /> 82 90 Gravel O Destroy <br /> Dosis We p—,d,,,and malmblt <br /> 90 105 Sand Gravel mdcr'GEDLOG+CtGG' <br /> 105 112 Sand Planned Uses <br /> 112 118 Sand gravel O Water Supply <br /> 118 130 Clay gravel _ j]Domestic ❑Public <br /> 130 145 Sand �� �� ' "� '_, w ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> 145 165 Sand Gravel <br /> O Dewatering <br /> 165 170 Gravel r <br /> O Heat Exchange <br /> 170 180 Sand I. 0Injection <br /> 180 186 Sand gravel ++1'Q O Monitoring <br /> 186 189 Sand Clay t' /SERV^ tLIO Remediation <br /> 189 209 Clay O Sparging <br /> 209 224 Sand clay SouthO Test Well <br /> 111 m,o.de—ba dmra—A­11 rmm mad.,wdnno,,I-- O Vapor Extraction <br /> 224 232 Clay gravel rivers.elceodadaahamep UeeaddIti—1papnlf11—sorry OOther <br /> 232 248 Sand Clay Plead bo accumto and com bio <br /> 248 252 Clay Gravel Water Level and Yield of Completed Well <br /> 252 264 Sand clay Depth to first water 98 (Feet below surface) <br /> Depth to Static <br /> 272 300 Sand Water Level (Feet) Date Measured <br /> Total Depth of Boring 300 Feet Estimated Yield' 30 (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 Te Material wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches (Inches) Feet to Feet <br /> 0 240 112 Blank PVC Sch.40 6 1 0 204 Bentonite Grout Well DF <br /> 240 300 12 Screen PVC Sch.40 6 10.032 204 300 Filter Pack Pea Gravel <br /> Attachments Certification Statement <br /> ❑Geologic Log I,the undersigned i that this report is complete and accurate to the best of my knowledge and belief <br /> C3 Well Construction Diagram Name Castle C t ction$Well Drilling <br /> E3 physical h slcal LO 5 Person, nrr.oral,on <br /> P Y g( ) 1418 J St Modesto CA 95354 <br /> ❑ Soil/Water Chemical Analyses s, Cay State 71r) <br /> ❑ Other Signed 05/17/2017 996768 <br /> Attach additional information d it ex'sts. C- 7 ensed Wafer well Contractor Date Signed C-57 License Number <br /> DWR 188 REV.112006 IF ADDITIONAL 5 E IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />