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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 Pa1 of 1 Well Completion Report �1-- --- _ Page Refer m Instruction Pamphlet State Well NumbedSite Number_ Owner's Well Number #2 No- e0313370 Date Work Began 06/09/2016 Date Work Ended 7/6/2016 Latitude N 1-0nude Local Permit Agency San Joaquin I I I I I t I i� Permit Number SR0074980 Permit Date 6/3/16 APNrrRSlOther Geologic Log Well Owner Orientation O Vertical O Horizontal OAngle Spaclty Name Robert Chartier Drilling Method Direct Rota Drilling Fluid Bentomte mud Mailing Address 32932 MacArthur Dr Depth from Surface Description Feet to Feet Describe material rain size color,etc City Tracy State CA Zi 95377 0 3 soil Well Location 3 9 brown clay Address 32932 MacArthur Dr 9 13 rock and gravel City Tracy County San Joaquin 13 18 clay Latitude N Longitude 18 32 rock and gravel Deo Min S. Dee Min sap 32 49 clay Datum Dec. Lat. Dec. Long. 49 52 silty sand and clay APN Book 253 Page 150 Parcel 06 52 75 brown clay with some gravel 1 Township -Range Section 75 182 course sand with gravel and rock streaks of clay Location Sketch Activit 82 91 sandy brown clay SkelCb must be drawn d.hm h.mr is pnntca (D New Well North O Modification/Repair 91 93 course sand with gravel and rock O Deepen 93 95 sandy brown clay OOther 95 97 course sand with gravel and rock O Destroyyaraa �a,aaaau 97 105 sandy brown clay :4orGEOLCGICLCC 105 106 streaks of course sand Planned Uses 106 135 brown sandy clay with mixed course sand O Water Supply 135 1149 harder brown clay _ ]Domestic ❑Public 149 152 course sand 3 w ❑Irrigation [Industrial O Cathodic Protection 152 165 courser brown sand clay O Dewatering 165 170 hard brown clay O Heat Exchange 170 245 course sand broken rock O Injection 245 253 hard tan clay O Monitoring 253 272 course sand and broken rock gravel O Remediation Spa272 275 hard tan cls O Test ng 275 300 soft dark brown cls stone SouthO Test Well Most'.sar domed,distance of wan vm oroods,nma.nos,ter O Vapor Extraction 300 1700 brown clay&layers1010 l a c and....., a«a«awnal,apa,J'ss., Q other ravel PIlI««aco...ana<,m IM. s0000000 Water Level and Yield of Completed Well AUG 2016 Depth to first water (Feet below surface) Depth to Static Fill,aR Water Leval 278 (Feet) Date Measured 07/01/2016 Total Depth of Boring 700 PFRs41T-4;r EALTH Estimated Yield' 15 (GPM) Test Type Air Lift Total Depth of Completed Well 700 Feet ES Test Length 1.0 (Hours) Total Drawdown 400 (Feet) *May not be re resentative of a welts 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 Fast io Feet Inches Inches Inches Intoes Feet to Feet 0 360 12 blank vc .327 5.563 0 200 grout sand&cement 360 380 12 screen pvc .327 5.563 slot 0.032 200 700 Isand #8 sand 380 420 12 1 blank 1pvc .327 5.563 420 700 12 screen 1pvc .327 5.563 slot 0.032 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 Martell Water Systems Inc Person.Firm or Corporation ❑ Geophysical Log(s) 1818 Lov r' oe Rd Pittsburg CA 94565 ❑ Soil/Water Chemical AnalysesAddress cdy stale c ❑ Other Signed Aeach eddioonal imam Deis dnexists C-5 Ltoenaed WSW wallContreclor Date Signed C-57 License Number DWR 185 REV Ir1OC6 IF ADDITIONAL SPACE IS NEEDEDUSE NEXT CONSECUTIVELY NUMBERED FORM