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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 /> Pagel of 1 Well Completion Report <br /> Refer to tnswa on Pamphlet State Well NumbedSite Number <br /> Owner's Well Number AMW-30S No. e0106874 Q Ili] <br /> Date Work Began 01/25/2010 Date Work Ended 1/26/2010 Latitude Longitude <br /> ' Local Permit Agency San Joaouin County <br /> Permit Number SR 0059147 Permit Date 1112/10 APN/TRS/Other <br /> Geologic Log Well Owner <br /> ' Orientation OVertical 0Horizontal OAngie Specify Name Forward Incorporated <br /> Drilling Method Mud Rotary Drilling Fluid Bentonite Mud Mailing Address 9999 South Austin Road <br /> Depth from Surface Description Manteca State CA �; <br /> Feet to Feet Describe material ize rain scolor,etc Cit 95336 <br /> ' 0.0 127.0 Blind drill to 127.0 feet below ground surface. Well Location <br /> Address 27011 South Ausfin Road <br /> City Ripon County San Joaquin <br /> Latitude 37 53 32.09 N Longitude -121 10 28.31 w <br /> ' Dec. Min. Sec. Dec. Min. Sec. <br /> Datum WIGS B4 Decimal Lat. 37.8922 Decimal Long.-121.1745 <br /> APN Book 181 Page_16 Parcel 7 <br /> Township 1N Ran a IE Section 35 <br /> ' Location Sketch Activity <br /> Skekdt must be drawn by hand after forth is tinted. Qe New Well <br /> North <br /> Q Modification/Repair <br /> O Deepen <br /> ' See attached O other <br /> FO Destroy <br /> Figure 1 <br /> Dearnl»proceduros and mabnats <br /> under*GEOLOGIC LOG <br /> Well Location Map Planned Uses <br /> ' O Water Supply <br /> []Domestic ❑Public <br /> ❑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 /> tlwtrate or deunbe distance or we111rom roads,nu;Wmas.fences. O Vapor Extraction <br /> r wra.ak.end attach a map Use additional paper H neoessary Q Other <br /> Mena he accurate and cornisloft. <br /> Water Level and Yield of Com feted Well <br /> Depth to first water (Feet below surface) <br /> ' Depth to Static <br /> Water Level 71.13 (Feet) Date Measured 06/14/2010 <br /> Total Depth of Boring 127 Feet Estimated Yield" (GPM) Test Type <br /> Total Depth of Completed Well 127 Feet Test Length (Hours)Total Drawdown (Feet) <br /> ' *May not be representative of a well's long term 'eld. <br /> Casings Annular Material <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Type it Any Surface Fill Description <br /> Feet to Feet Inches Inches inches inches Feet to Feet <br /> 0 107 8 Blank PVC Sch.80 0.375 2.75 0.0 98.5 cement Portland <br /> 107 127 8 Screen PVC Sch.80 0.375 2.75 Milled Slots 0.010 98.5 102.0 Bentonite Pellets <br /> 102.0 127.0 Filter Pack #2/12 Sand <br /> Attachments Certification Statement <br /> ' I]Geologic Log t,the unde art' his re i comple urate to the best of my knowledge and belief <br /> I]Well Construction Diagram Name n t <br /> ❑Geophysical Log(s) CA q5;V 5 <br /> ❑Soil/Water Chemical Analysesa crcy Stale Z <br /> 13 Other Signed �� )Q <br /> ' Attach additional information if it masts. C57 Licensed water well Contractor Date Signed C-57 License Number <br /> L-1 <br /> DWR 188 REV,112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />