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1 ' The free Atiobe 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 N W Date Work Began 08/03/2016 Date Work Ended 8/25/2016 Latitude Longitude Local Permit Agency San Joaauin County Permit Number SR-0075422 Permit Date 7/28/16 APN/7RS/Other Geologic Log Well Owner Orientation O Vertical O Horizontal OAngle Specify Name city of Manteca public works Drilling Method Drilling Fluid Mailing Address 1001 Center St. Depth from Surface Description Feet to Feet Describe material,grain size,color,etc City Manteca State-22--Zip 95337 0 40 fine sand Well Location 40 50 coarse sand Address 1329 Woodward ave. 50 60 brown clay City Manteca County San Joaquin 60 70 sand and small gravel Latitude 37 46 30 N Longitude 121 14 26___�N 70 80 brown clay Dec. Min. sec. Dea. Min Sec, 80 100 coarse sand and gravel Datum Dec.Lat. Dec. Long. 100 120 brown clay APN Book 266 Page 180 Parcel 150 120 130 clay and sand Township —Range Section 130 140 cnarsP sand Location Sketch Activitv Sketch must be drawn by hand after form isrinted. O• New Well 140 150 coarse gravel North Q Modification/Repair 150 160 sand and gravel O Deepen 160 190 brown clay O Other 190 200 coarse sand Q Destroy Dascrlbe procedures end metenels 200 230 brown Clay under'GEOLOGIC LOG" 230 250 coarse sand and gravel Planned Uses 250 270 coarse gravel and sand Q Water Supply❑p Domestic ❑Public 270 280 sand 280 300 gray blue clay w ❑Irrigation ❑Industrial Q Cathodic Protection Q Dewatering Q Heat Exchange Q Injection OMonitoring O Remediation Q Sparging s•-,•�. South Q Test Well i' nwsnate or describe distance of well from reeds,buildings,fences. Q Vapor Extraction r—rs coin uleets dr if necessery Q Other Paese cc Unit— Waterbee1-14-11 Level and Yield of Completed Wellt Depth to first water 80 (Feet below surface) Depth to Static Water Level 60 (Feet) Date Measured 08/25/2016 rT.t.1epth of Boring 300 Feet Estimated Yield' 350 (GPM) Test Type Air Lift Total Depth of Completed Well 300 Feet Test Length 8.0 (Hours) Total Drawdown (Feet) *May not be re resentative of a well's long term yield. Casings Annular Material Depth from Borehole Wall Outside Screen Slot Size Depth from Surface Diameter Type Material Thickness Diameter Type if Any Surface Fill Description Feet to Feet Inches Inches Inches Inches Feet to Feet 0 145 48 Conductor Low Carbon Steel .250 30 0 50 Cement 10.5 cement/sand 0 140 24 Blank Low Carbon Steel .312 12.75 50 300 Filter Pack birds eye qravel 140 160 24 Screen Low Carbon Steel .312 12.75 Milled Slots 0.050 160 220 24 Blank Low Carbon Steel .312 12.75 220 280 24 Screen Low Carbon Steel .312 12.75 Milled Slots 0.050 280 300 24 Blank Low Carbon Steel 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 Nor-Cal Pump and Well Drilling E3 Geophysical Log(s) 1325 BarrrsfndFtrmorCorporaton Yuba City CA 95993 ❑ Soil/Water Chemical Analyses f Addre City state zip ❑ Other Signed — 9/21/2016 908591 Attach additional information.if It exists. C-5X Oclensed vv +(veu Contractor Date Signed C-57 License Number DWR 188 REV.1/2006 IF ADDITIONAL-,PVF IS NEED.USE NEXT CONSECUTIVELY NUMBERED FORM