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t <br /> .The free Adobe Reader may be used to view and complete thi However,software must be purchased to complete,save, use a saved form. <br /> File Original with DWR State of California DWR Use Only-Do Not Fill In <br /> Well Completion Report <br /> Page Of Refer to Instruction Pamphlet <br /> State Well Numbed <br /> Owner's Well Number MW-31 No. e0265041 NI iNumber <br /> W <br /> Date Work Began 03/31/2015 Date Work Ended 3/31/2015 Latitude Longitude _ <br /> Local Permit Agency San Juaauin Cnty Environmental Health DeDartment I 1 _I I I 1 1 1 i I 1 <br /> Permit Number 198-160-22 Permit Date 7/25/15 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation OVertical O Horizontal OAngle Specify Name A Rossi INC <br /> Drilling Method Auger Drilling Fluid <br /> Mailing Address 611 N. Main St. <br /> Depth from Surface Description <br /> Feet to Feet Describe material,grain size,color,etc City Manteca State Ca lip 95336 <br /> 0 20 Fine silty sand Well Location <br /> 20 31 Fine course sand/rounded pea gravel mix Address 495 Airport Way <br /> City Manteca County <br /> Latitude N Longitude W <br /> Deq. Min. Sec. Dea. Min. Sec. <br /> Datum Dec.Lat. Dec. Long. <br /> APN Book Page Parcel <br /> Township -Range Section <br /> Location Sketch Activit <br /> Sketch must be drawn by hand after form isprinted.) 0 New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> O Destroy <br /> Describe procedures and materials <br /> under'GEOLOGIC 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 /> 0 Sparging <br /> South O Test Well <br /> Illustrate ar describe distance ofwell from roads,buildings,fences. <br /> O Vapor Extraction <br /> rivers,etcand attach a map. Use additional paper if necessary. O 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 31 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 Type Material Wall Outside Screen Slot Size Depth from <br /> Surface Diameter yP Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 31 21 18 Screen JPVC SCH40 2" Slot 10.020 31 119 Sand #3 <br /> 21 0 8 Blank PVC SCH 46 2" 19 17 Bentonite Chips <br /> 17 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 /> ❑ LO Person,Firm or Corporation <br /> Geophysical <br /> g(S) 3000 Duluth West Sacramento CA <br /> ❑ Soil/Water Chemical Analyses A rs cit <br /> state zip <br /> El Other Signed 12 �( �yr— `� Zoj 938110 <br /> Attach additional information,if it exists. C-57 U n e,.water well Contractor Date Si ned C-57 License Number <br /> DWR 188 REV.112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />