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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. File Original with DWR State of California DWR Use Only—Do Not Fill In Well Completion Report Page 1 Of 1 Refer to Instruction Pamphlet State Well Number/Site Number Owner's Well Number No. e0342699 I I Date Work Began 05/01/2017 Date Work Ended 5111/2017 Latitude N Longitude W Local Permit Agency San Joaquin County Environmental Health DeDt. Permit Number SR0076961 Permit Date 3/15/17 APN/TRS/Other Geologic Log Well Owner Orientation OVertical 0Horizontal OAngle Specify Name Brian Wise Drilling Method Mud Rotary Drilling Fluid Water Depth from Surface Description Mailing Address 25700 S Lammers rd Feet to Feet Describe material,grain size,color,etc City Tracy State Chi 95377 0 1 Top Soil dh�t 'r Well Location 1 9 Clay Address 25960 S Lammers Rd 9 10 Sand 9 0, City Tracy County San Joaquin 10 23 Clay Latitude N Longitude w 23 26 Clay with Sand streaks 1i -,4ENT Dea. Min Sec. Dea. Min Sec. 26 35 Clay 7.1",'/GERM �, ` Datum Dec. Lat. Dec. Long. 35 45 Clay with sand streaks APN Book24— Page 060 Parcel 06 45 50 Clay Township Range Section 50 55 Sand Location Sketch Activit 55 65 Clay Sketch must be drawn b hand after form is printed.) Q New Well y North 65 70 Sand and gravel O Modification/Repair O Deepen 70 145 Clay O Other 145 151 Sand and gravel O Destroy Describe procedures and materials 151 184 Blue clay under'GEOLOGIC LOG' 184 187 Sand and gravel Planned Uses 187 195 Blue clay O Water Supply 195 203 Sand and gravel ❑� Domestic []Public 203 210 Blue clay w Lu ❑Industrial 210 220 Clay O Cathodic Protection O Dewatering 220 222 Gravel O Heat Exchange 222 250 Clay with sand streaks O Injection 250 252 Gravel O Monitoring 252 300 Clay O Remediation 300 312 Sand and gravel O Sparging O Test Well South 312 325 clay Illustrate or describe distance of well from roads,buildings,fences. O Vapor Extraction rivers.etcand allacD a map. Use additional paper if necessary. O Other Please be accurate and com let.. Water Level and Yield of Completed Well Depth to first water (Feet below surface) Depth to Static Water Level 132 (Feet) Date Measured Total Depth of Boring 325 Feet Estimated Yield' (GPM) Test Type Total Depth of Completed Well 315 Feet Test Length (Hours) Total Drawdown (Feet) L22y not be representative of a well's long term yield. Casings Annular Material Depth from Borehole Type Material wall Outside Screen Slot Size Depth from Surface Diameter yp Thickness Diameter Type it Any Surface Fill Description Feet to Feet Inches Inches Inches Inches Feet to Feet 0 295 14 Blank PVC .322 8 0 156 Bentonite Quik Grout 295 315 14 Perforated PVC .322 8 0.050 156 315 Filter Pack No. 6 sand pack Attachments Certification Statement ❑ Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief ❑ Well Construction Diagram Name Hennings Bros. Drilling Co., Inc. Person,Firm or Corporation El Geophysical Log(s) 1930 Ladd Rd ModestD CA 95356 ❑ Soil/Water Chemical Analyses Address city State zip ❑ Other Signed 2 M 05-18-17 290813 Attach additional information,if it exists. C-57 Licensed Water Well Contractor Date Signed C-57 License Number DWR 16a REV.112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIV LY NUMBERED FORM