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The free Adobe Reader may be u,ad to view and complete this form. However,software must be purchased to complete,save,and reuse a saved form. <br /> r Filo Original with DWR State of California W DWR Use O -Do Not FlII In <br /> Page of • Well Completion Report <br /> Refer to Instruction Pamphlet <br /> Owners Well Number MW-125A NoState Well Number/Site Number <br /> NO- e0167731 I�f�-� <br /> Date Work Began 11/27/2012 Date Work Ended 11/27/2012w <br /> Latitude Lon <br /> Local Permit Agency San JoaDLin Co Inthr 1= riMorr ntal Health <br /> Permit Number66103 Permit Date 11/7/12 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation OVertical 0Horizontal OAngle Specify Name Arcadis <br /> Drilling Method Sonic Drilling Fluid <br /> Depth from Surface Description Mailing Address 2000 Powell St 7th Floor <br /> Feet b Feet Describe material grain size,color,etc city Emeryville State CA 7 94608 <br /> 0 10 Sandy silts,some clayWell Location <br /> 10 18 Well graded sand,fine to coarse,some silty clayey Address 455 W Lincoln Road <br /> sand City Stockton County San Joaquin <br /> 18 23 No recovery Latitude <br /> Longitude <br /> 23 27 Sand,wN o <br /> well graded,fine to medium Der,. Min. Sec. Dee. Min. sec_ W <br /> 27 28 Sandy silts with pockets of thick black clay Datum Decimal Let Decimal Long. <br /> 2B 30 No recovery APN Book Page Parcel <br /> 30 32 Sandy silts with some clay Township Ran a Section <br /> 32 39 Sandy gravels with some silts Location SketchActivity <br /> 39 42 Silts and very fine sand Sketch must be drawn by hand aftarlp is ranted. • New Well <br /> 42 44 Silts with some fine grained sand North O Modification/Repair <br /> O Deepen <br /> O Other <br /> - <br /> 0 Destroy <br /> -GEOLOGIC Lod- <br /> Planned <br /> LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> w ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> 0 Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> Iruatrate 01 m.0am,euiai ,Temno, O Vapor Extraction <br /> eo...and.n.mam.,.maaadvanalwwr anaao,an. O Other <br /> Plea"pa accunb and cam Nb. <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 44 Feet Estimated Yield• (GPM) Test Type <br /> Total Depth of Completed Well 42 Feet Test Length (Hours)Total Drawdown_(Feet) <br /> *May not be re resentative 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 Feel to Feet <br /> 0 32 6 7/8 Blank PVC Sch 80 2 0 28 Neat Cement <br /> 32 42 6 7/8 Screen PVC SCh 60 2 Slot0.010 28 30 Bentonite Pellets <br /> 30 44 Sand 2/12 <br /> Attachments Certification Statement <br /> ❑Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑ Well Construction Diagram Name Cascade Drillino.L.P. <br /> ❑ Geophysical Log(s) Person,Finn or Corporation <br /> 11 Soil/Water Chemical Analyses <br /> 3632 Om c Circle Rancho Cordova CA 95742 <br /> �dr ss city _SZ-7 Zip17 Other Site Mao Signed 01/08/13 938110 <br /> Attach additional in(armation I itexists. C-6]Ucensed water wait coh6acto, Date Signed G57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />