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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 Page 1 of 1 Well Completion Report Refer to Instruction Pamphlet State Well Number/Site Number Owner's Well Number No. xxxxxxx 111-1N11 11111yy Date Work Began 05/01/2017 Date Work Ended 5/7/2017 Latitude Longitude Local Permit Agency San Joaquin County Permit Number SR0077308 Permit Date 4/26/17 APN/TRS/Other Geologic Log Well Owner Orientation O Vertical O Horizontal OAngle Specify Name Carole Sletton Drilling Method Direct Rotary Drilling Fluid Fresh Water Mailing Address 28513 Lemon Ave Depth from Surface Description Cit escalon State-29--Zip Feet to Feet Describe material, rain size,color,etc 0 7 Top Well Location 7 25 Sand Address Same 25 33 Coarse sand City County San Joaquin 33 40 Clay sand Latitude N Longitude �v 40 46 sand Deq. Min. Sec. Dec. Min. Sec. 46 50 Clay Datum Dec.Lat. Dec.Long. 50 54 Sand APN Book Page Parcel 54 62 Clay Township -Range Section 62 66 Sand Location Sketch Activit 66 76 Clay Sketch must be drawn b hand after form is Anted. Q New Well North 76 80 Sand/Clay O Modification/Repair O Deepen 80 82 Clay/Gravel O Other 82 90 Gravel O Destroy Describe procedures and materials 90 105 Sand Gravel under-GEOLOGIC LOG" 105 112 Sand Planned Uses 112 118 Sand gravel O Water Supply 118 130 Clay gravel W Domestic El Public ❑ 130 145 Sand w ' ,k , w Irrigation ❑Industrial O Cathodic Protection 145 165 Sand Gravel O Dewatering 165 170 Gravel •-i, G � O Heat Exchange 170 180 Sand 0Injection 180 186 Sand gravelr. AI-, O Monitoring 186 189 Sand Clay ffJI&ERVI^ O Remediation 189 209 Clay O Sparging 209 224 Sand clay South O Test Well Illustrate ordescribe distance ofwell from roads, buildings,fences, O Vapor Extraction 224 232 Clay gravel rivers,etc.and attach a map.Use additional paper If necessary. O Other 232 248 Sand Clay Please beaccurmte and complete.. 248 252 Clay Gravel Water Level and Yield of Completed Well 252 264 Sand clay Depth to first water 98 (Feet below surface) Depth to Static 272 300 Sand Water Level (Feet) Date Measured Total Depth of Boring 300 Feet Estimated Yield* 30 (GPM) Test Type Total Depth of Completed Well 300 Feet Test Length (Hours) Total Drawdown (Feet) *May 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 if Any Surface Fill Description Feet to Feet Inches Inches Inches Inches Feet to Feet 0 240 112 Blank PVC Sch.40 6 0 204 Bentonite Grout Well DF 240 300 12 Screen PVC Sch.40 6 0.032 204 300 Filter Pack Pea Gravel Attachments Certification Statement ❑Geologic Log I,the undersignedi that this report is complete and accurate to the best of my knowledge and belief El Well Construction Diagram Name Castle C t ction&Well Drilling 11Geophysical Log(s) 1418 J Sterson, i o orporation Modesto CA 95354 ❑ Soil/Water Chemical Analyses s, City State zip ❑ Other Signed 05/17/2017 996768 Attach additional information if it exists. C-7 Rensed Water Well Contractor Date Signed C-57 License Number DWR 188 REV.1/2006 IF ADDITIONALS E IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM