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'Thefree Adobe Reader maybe used to view and corrAllilkithisform. -However, sonware must be purchased to comple e, and reuse a saved:form, File Original with DWR State of California 'age 1 of 1 Well Completion Report Refer to Instruction Pamphlet Owners Well Number MW1A No. e0185659 Date Work Began 06/05/2013 Date Work Ended 6/6/2013 Local Permit Agency man Joaquin END Permit Number 67123 Permit Date 5/9/13 Orientation O Vertical O Horizontal OAngle Specify Drilling Method Direct Rota Drilling Fluid Bentonite mud Depth from Surface Feet to feet Description Describe material grain size calor, etc 0 5 Dark Gray Silty Clay 5 15 Dark Gray to Dark Brown Sandstone 15 20 Dark Gray Claystone, 20 35 Dark Brown Sandstone 35 55 Dark Gray Brown Sandy Siltstone 55 60 Gray Brown Silty Claystone 60 75 Brown Silty Sandstone 75 80 Brown Siltstone 80 85 Brown Silty Claystone 85, 90 Brown Sandy Siltstone 90 95 Dark Gray Brown Sandstone 95 100 Brown Siltstone 100 105 Brown Silty Sand 105 110 Brown Sandy Silt 110 125 Brown to Gray Brown silty Claystone 125 140 Dark Gray to Dark Gray Brown Sandstone 140 171 Dark Brown Silty Sandstone 171 175 Dark Gray Brown Clayey Sand 175 185 Dark Gray Brown Sand to Silty Sand 185 195 Brown Silty Cal 195 200 Brown Clayey Siltstone 200 210 Dark Gray Brown Sand 210 215 Dark Gray Brown Sandy Silt 215 1225 1 Dark Gray Brown Sand with Clay 225 J 227 1 Brown Siltstone Total Depth of Boring 226.5 Feet Total Depth of Completed Well 225 Feet DWR Use Only — Do Not Fill in F tate Well Number/Site NumberI I IJe Longitude APNI TRS/Other Name San Joaauin County Public Works - Solid Waste Mailing Address 1810 East Hazelton City State 7io Well LocataOn Address 6484 North Waverly Road City Linden County San Joaquin Latitude N Longitude w Dec. Min. Sec. Deo. Min. Sec. Datum Dec. Lat. Dec. Long. APN Book 093 Page 44 Parcel 002 Sketch must be drawn by hand "affer form isrinted. O NeW Well Q Modification/Repair O Deepen North p fA (04 O Other Material O Destroy Describe procedures and materials *GEOLOGIC slot size If Any Inches under LOG' Planned Uses PVC Sch. 80 O Water Supply 1 0 190 Cement ❑ Domestic ❑ Public 3 w ❑Irrigation ❑industrial 0.020 O Cathodic Protection Q O Dewatering 1 O Heat Exchange v0 Injection V \ O Monitoring 0.020 Remediation 1O Z O Sparging O Test Well South O Vapor Extraction Hiustrate or describe &Knee of well from roads, buildings, fences, rivers, etc. and swat a map. Use additional paper if necessary. � ., .d O Other Depth to first water (Feet below surface) Depth to Static Water Level (Feet) Date Measured Estimated Yield * (GPM) Test Type Test Length (Hours) Total Drawdown (Feet) *Mav not be renresentative of a wail's Innn term vipid DWR 188 REV. 1/2008 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM Casings Annular Material Depth from Borehole Surface Diameter Type Feet to Feet inches Material wall Outside Screen Thickness Diameter Type Inches Inches slot size If Any Inches Depth from Surface Fill Description Feet to Feet 0 1205 10 Blank PVC Sch. 80 12.375 1 0 190 Cement 205 1225 10 Screen PVC Sch. 80 2.375 Milled Slots 0.020 190 200 Bentonite Pellets 0 205 10 Blank PVC Sch. 80 1.25 11200 227 Filter Pack 2/12 sand 205 225 10 Screen PVC Sch. 80 1,25 Milled Slots 0.020 Attachments Certification Statement ❑ Geologic Log ❑ Well Construction Diagram ❑ Geophysical Log(s) ❑ Soil/Water Chemical Analyses [3 Other Attachadditional information if it exists. 11 I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief Name Grego Drilling and Testing. Inc Person, Firm or Corporation 950 H we Rd Martinez CA 94553 Ad city State zip Signed - rJz 485165 C-57 icensad Water"Cltor Date Signed C-57 License Number DWR 188 REV. 1/2008 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM