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`free Adobe Reader may be used to view and complete t' m. However,software must be purchased to complete,save euse a saved form. <br /> File Original with DWR State of California DWR Use Only-Do Not Fill In <br /> Page of Well Completion Report <br /> Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number MW-26 No. e0265050 <br /> INI I I I I IWI <br /> Date Work Began 03/03/2015 Date Work Ended 3/3/2015 Latitude Lon nude <br /> Local Permit Agency San Juaauin Cnty Environmental Health Department <br /> Permit Number 200-140-08 Permit Date 7/25/15 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name. !:11;'.v,I e_( a u S�-l,*' <br /> Drilling Method Auger Drilling Fluid <br /> 14 <br /> Depth from Surface-- - ---- -•-------Description-.. Mailing Address Ia Q 1\14. /�1 C # t .�� <br /> Feet to Feet Describe material, rain size,color etc City Manteca State C—lip 95336 <br /> 0 20 Brown Fine silty sands Well Location <br /> 20 40 Well Graded sands fine/course Address <br /> 40 60 City Manteca <br /> County <br /> 60 80 Silty clay Yellowish Brown Latitude N Longitude W <br /> 80 100 fine course sands Dea. Min. Sec. Dee. Min. Sec. <br /> Datum Dec.Lat. Dec.Long. <br /> APN Book Page Parcel <br /> Township Ran e Section <br /> Location Sketch Activit <br /> Sketch must be drawn by hand after form isprinted.) Qi New Well <br /> North <br /> Q Modification/Repair <br /> O Deepen <br /> O Other <br /> Q Destroy <br /> Describe procedures and matenals <br /> under'GEOLOGICLOG' <br /> Planned Uses <br /> Q Water Supply <br /> ❑Domestic ❑Public <br /> 3 ti ❑Irrigation ❑Industrial <br /> Q Cathodic Protection <br /> Q Dewatering <br /> O Heat Exchange <br /> Q Injection <br /> (D Monitoring <br /> O Remediation <br /> Q Sparging <br /> South Q Test Well <br /> Illustrate or describe distance of well from roads,bulldings,fences. Q vapor Extraction <br /> rivers,etc.and attach a map.Use additional paper if necessary. Q Other <br /> Please be accurate and complete <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 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 100 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 Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 100 90 8 Screen 1PVC SCH40 2" Slot 10.020 100 188 Sand #3 <br /> 90 0 8 Blank PVC SCH 4h 2" 88 86 Bentonite Chips <br /> 86 0 Cement Portland <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 Cascad Drilling L.P. <br /> Geophysical LO Person,Firm or Corporation <br /> g(S) 3000 Duluth West Sacramento CA <br /> ❑ Soil/Water Chemical AnalysesAddr at state zip <br /> ❑ Other Signed 938110 <br /> Attach additional information,if it exists. C- Icensed ater ell Contractor Date Signed C-57 License Number <br /> DWR 188 REV.112005 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />