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'The free Adobe Reader may be used to view and complete thin However,software must be purchased to complete,save,< Ise 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 /> Re/er to Instruction Pamphlet State Well Number/Site Number�I <br /> Owner's Well Number MW-32 No. e0265044 �I I I I I -1 w <br /> Date Work Began 03/31/2015 Date Work Ended 3/31/2015 Latitude Longitude <br /> Local Permit Agency San Juaouin Cnty Environmental Health Department <br /> Permit Number 198-160-22 Permit Date 7/25/15 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical 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 Zip 95336 <br /> 0 20 Brown Fine sands Well Location <br /> 20 40 Fine course sands Address 495 Airport Way <br /> 40 60 Gravel City Manteca County <br /> 60 80 Yellow Silty Clay Latitude N Longitude W <br /> 80 90 Well Graded sand 5,90,5 fines to course Brwn Grd DeQ 7M7Sec. Dea. Min. Sec. <br /> 90 104 Silty snads Yellowish Brown 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.) New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> Q Destroy <br /> Describe procedures and materials <br /> under'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> u ❑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 /> Illustrate or describe d¢tance of well from roads,buildings,fences, O Vapor Extraction <br /> rivers,etc.and 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 104 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 /> 104 94 8 Screen PVC SCH40 2" Slot 0.020 104 92 Sand #3 <br /> 94 0 8 Blank PVC SCH 4b 2" 92 90 Bentonite Chips <br /> 90 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 /> Person,Firm or Corporation <br /> ❑ Geophysical Log(s) 3000 Duluth West Sacramento CA <br /> ❑ Soil/Water Chemical Analyses � ��—�� Cig�–� Stale zip <br /> ❑ Other Signed r J 938110 <br /> Attach additional information,if it exists. T C-57 Licensed Water Well Contractor Date SI ned C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />