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<br /> ' File Original with DWR State of California
<br /> DWR Use Only-Do Not Fill In
<br /> Page 4 of 6 Well Completion Report
<br /> Rorer to Inshuction Pamphlet Slate Well Number/Site Number
<br /> Owner's Well Number AMW-30 No. e0106293 N LL I I I I I 1W
<br /> ' Date Work Began 01/18/2010 Date Work Ended_01/22/2010 Latitude Longitude
<br /> Local Permit Agency San Joaouin County
<br /> Permit Number SR 0059145 Permit Date 1/12/10 APN/TRSIOthsr
<br /> Geologic Log Well Owner
<br /> Orientation G Vertical O Horizontal OAngle Specify Name_Forward Incorporated
<br /> Drilling Method Mud Rotary Drilling Fluid Bentonite mud =
<br /> Mailing Address 9999 South Austin Road
<br /> Depth from Surface Description Manteca
<br /> Feet to Feet Describe material rain size color,etc C State_CA__Zip 95336
<br /> ' 105.0 106.5 SAND,moist,loose,fine to coarse grained,poorly Weil Location
<br /> sorted,subrounded,mica throughout,dark grayish. Address 27011 South Austin Road
<br /> brown(10YR 4/2). Contains 5%fine gravel at City Ripon County San Joaquin
<br /> 105.5 through 105.8 ft. Latitude 37 53 32.20
<br /> N Longitude -121 10 28.31
<br /> 106.5 110.0 SAND. Dec. Mn. sec. Dec. Min. Sac,
<br /> 110.0 111.0 SAND,moist,loose,fine to coarse grained,poorly Datum WGs 84 Decimal LaL 37.8923 Decimal Long.-121.1745
<br /> sorted,subrounded,mica throughout,dark grayish APN Book 181 Page 16 Parcel 7
<br /> brown(10YR 4/2). Contains 20%fine gravel Township 1 N Ra2se 7E Section 35
<br /> throughout. Location Sketch Activity
<br /> Sketch must be drawn b hand after form Is Printed.)
<br /> 111.0 115.0 SAND. North {O New Well
<br /> 115.0 115.3 Silty CLAY with trace sand,dry,stiff,slightly O Modification/Repair
<br /> plastic,dark grayish brown(10YR 4/2). ©DOttheren
<br /> 115.3 116.1 SAND,moist,loose,fine to coarse rained,poorly See attached O Destroy
<br /> Figure 1 Descnte mosedmaand materials
<br /> sorted,subrounded,mica throughout,dark I undar•6EOLOGIC Loa
<br /> yellowish brown 1OYR 4/6). Well Location Map Planned Uses
<br /> ' 116.1 120.0 SAND. O Water Supply
<br /> 120.0 121.0 SAND,moist,loose,fine to coarse grained,poorly ❑Domestic pPublic
<br /> sorted,subrounded,mica throughout,dark grayish 3 [:]Irrigation [:]Industrial
<br /> ' brown(10YR 4/2). Contains 20%fine ravel O Cathodic Protection
<br /> O Dewatering
<br /> throughout. O Heal Exchange
<br /> 121.0 125.0 SAND. 0Injection
<br /> ' 125.0 125.5 SAND,moist,loose,medium to coarse grained, G Monitoring
<br /> poorly sorted,subrounded to subangular,brown O Remediation
<br /> 00YR 4/3). Contains mica and 20%fine grained O Sparging
<br /> ravel throughout. South O Test Well
<br /> ' 125.5 125.9 SAND,moist,loose,fine to coarse rained, oorl Mtrama�neem,~amdwalean ,e�wn�.Wcos. O Vapor Extraction
<br /> g p y ditm,aro.and aitaeh a map.Use adQtlonal paper H necessary. O Other
<br /> sorted,subrounded,mica throughout,dark grayish PI.-b.." a"an°
<br /> brown(10YR 4/2). Water Level and/field of Completed Well
<br /> 125.9 130.0' SAND. Depth to first water (Feet below surface)Depth to Static
<br /> Water Level 71.49 (Feet) Date Measured 06/14/2010
<br /> Total Depth of Boring 177 Feet Estimated Yield` (GPM) Test Type
<br /> Total Depth of Completed Well 177 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 Wall Outside Screen Slot Size Depth from
<br /> Surface Diameter Type Material Thickness Diameter Type if Any Surface Fill Description
<br /> t Feet to Feel Inches Inches Inches Inches Feet to Feet
<br /> 0 157 8 Blank PVC Sch.80 0.375 2.75 1 0.0 1151.2 JCement Portland
<br /> 157 177 8 Screen PVC Sch.80 0.375 2.75 Milled Slots 0.010 151.2 1154.0 Bentonite Pellets
<br /> 154.0 177.0 Filter Pack W2112 Sand
<br /> Attachments Certification Statement
<br /> El Geologic Log I,the undo Idify thlttthis repo com teteg cu to to the best of my knowledge and belief
<br /> D Well Construction Diagram Name `J lf/t/l 1
<br /> rson Fi ar
<br /> ❑Geophysical Log(s) a.3 .CA 5a•U 15
<br /> ED SotWVater Chemical Analyses city state p!�
<br /> ❑Other Signed 7 (0310 U7
<br /> Attach additional information N it exists. C-67 Licensed water Well Contractor Date a S�C-57 License Number
<br /> DWR 188 REV.112005 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM
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