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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 On —Do Not Fill In <br /> Page of Well Completion Report <br /> Refer to Instruction Pamphlet <br /> Owner's Well Number MW-216A State WeII Number/Site Number <br /> No. e0167740 �T <br /> Date Work Began 10/11/2012 Date Work Ended 10/11/2012 L-1 1--J--1 --1 W <br /> Local Permit Agency San JOaouin County Prironm nt^I Health <br /> Longitude <br /> Permit Number 65828 L <br /> PerrinitDate <br /> APN/TR5/0ther <br /> Geolo is 10-9— Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name Arcadis <br /> Drilling Method Sonic Drilling Fluid <br /> Depth from Surface Description Mailing Address 2000 Powell St 7th Floor <br /> Feel m Feet Describe material rain size color,etc Ci Emeryville State CA �i 94608 <br /> 0 11 Silt with Trace Clay Well Location <br /> 11 19 Sandy Silts Address 555 W Benjamin Holt <br /> 19 20 Fine rained sand with silts and trace clayCity St -&55 <br /> Joaquin <br /> 20 22 Silty sands and thick clay County <br /> 22 24 Hard sandy clay Latitude N Longitude _ _J,y <br /> Dep. Min. Sec. Deo. Min. Sec. <br /> 24 25 Sandy clay with trace silt Datum Decimal Lat. Decimal Long. <br /> 25 34 Clayey Sand APN Book Page Parcel <br /> 34 41 Clay,contains silts Township Range Section <br /> 41 50 Sand,fine to medium Location Sketch Activit <br /> 50 54 Fine to coarse grained sand <br /> (Sketch must be drawn b nand after form is printed Q New WeII <br /> 54 57 Sandy silt with trace clay North O Modification/Repair <br /> O Deepen <br /> O Other <br /> — <br /> 0 Destroy <br /> nucnCe pmcMu,m am malavb <br /> uMx'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic E3 Public <br /> WO ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> OO Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> nimvareord®area dmama ot%mI rt—d,buiamys.rmom. O Vapor Extraction <br /> mnn,aa.aadanam amap <br /> .use aadnmaa aaoa,anm�a,y. O Other <br /> vr.a.a b..aau,a..,,a aam Nr.. <br /> ater 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 57 Feet Estimated Yeld a (GPM) Test Type <br /> Total Depth of completed Well 55 Feet Test Length (Hours) Total Drawdown_(Feet) <br /> *May not be rem entative of a well's lon tern ield. <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 m Feet Inches InchesInches Inches Feel to Feet <br /> 0 35 67/8 Stank PVC Sch 80 2 0 31 Neat Cement <br /> 35 55 67/8 screen PVC ch <br /> 80 2 Slot 0.010 31 33 Bentonite Pellets <br /> 33 57 Sand y12 <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 /> ElWeII Construction Diagram Name Cascade Drill g, L.P. <br /> ❑ Geophysical Log(s) Person,FIm or Coloration <br /> 3632 Omec Circle Rancho Cordova CA 95742 <br /> 11y Soil/Water Chemical Analyses T 1— city stale Zip <br /> ❑y Other Site Mao Signed `--�A /l J o r�,e v— 01/08/13 938110 <br /> Attach addi8onal Information,it it exists. C-57 Ucensed Wa tractor Date Signed C-57 License Number <br /> Dm 188 REV.1/2008 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />