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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 On -Do Not FIN In Well Completion Report Page 1 of 1 Refer to instruction Pamphkr State Well Number/Site Number Owners Well Number No. xxxxxxx Date Work Began 08/03/2016 Date Work Ended 8/25/2016 Latitude L 'nude Local Permit Agency San JoaouiIT County Permit Number 5R-0075422 Permit Date 7/28/16 APNrtRS/Other Geologic Log Well Owner Orientation O Vertical O Horizontal OAngle Speciry Name Woodside Homes LLP Drilling Method Drilling Fluid Depth from Surface Description Address 3 Woodmere rd. Feet to Fast Describe material rain size color,etc City Folsom State.22—Zip 95630 0 40 fine sand Well Location 40 50 coarse sandRFC lill ress 1329 Woodward ave. 50 60 brown clay City Manteca County San Joaquin 60 70 sand and small gravel SCPLatitude 37 46 30 N Longitude 121 14 26 70 80 brown clay Deo. Min. Sec. Den. n�n sec. 8o 100 coarse sand and gravel E Datum Dec.Lal. Dec Long 100 120 brown clay pE );�N Book 266 Page 180 Parcel 150 120 130 clay and sand Townshi —Range Section 130 140 coarse sand _..._ ____ _ _. . Location Sketch Activity 140 150 coarse gravel Sketch must be drawn by hand after form b rintaa. •O New Well North O Modification/Repair 150 160 sand and gravel O Deepen 160 1190 1 brown clay O Other 190 200 coarse sand �, O Destroy / o.,'G lawadveLOG'me.n,: 200 230 brown da �WereoLocic Loc' 230 250 coarse sand and gravel 14� Planned Uses 250 270 coarse ravel and sand i O Water Supply Domestic ❑Public 270 280 sand ;\�2-L�? h[11151nIG Is U ❑Imgation ❑Industrial 280 300 grey blue Gay 3 JA� w O Cathodic Protection jO Dewatering O Heat Exchange O Injection _ 0 Monitoring 7 O Remediation O Sparging ul' South dV O Test Well Illwaw.ar a.ofxewecem+.mro,,,, d.,wluire..rt—, O Vapor Extraction O Other nw..w.aer.h.m.om i.r.. star Level and Yield of Completed Well Depth to first water 80 (Feet below surface) Depth to Static Water Level 60 (Feet) Date Measured 08/25/2016 Total Depth 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 representative 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 Feel to Feet Inches Inches Inches Inches Feet to Feet 0 45 48 lConductor I Low Carbon Steel 1.250 130 1 1 0 50 Cement 10.5 cement/sand 0 140 24 1 Blank Low Carbon Steel .312 12.75 50 300 Filter Peck birds eye gravel 140 160 24 1 Screen Low Carbon Steel .312 12.75 Milled Slots 0.050 160 220 24 Blank Law Carbon Steel .312 12.75 220 280 24 1 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 Drillino ❑GeophysicalL S Person,nmor Cmporetion Log(s) 1325 ar rd. Yuba City CA 95993 11 Soil/Water Chemical Analyses Address Cily state zip 11 Other Signed Ga � \C�' 9/21/2016 908591 Attach additionsl information 8 it exists. CC-57 eb IComraaorr— Dale Signed G-57 License Number DWR 188 REV.112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM