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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 Well Completion Report Page 1 Of 1 Refer to Instruction Pamphlet State Well Number/Site Number Owner's Well Number SR0077520 No. xxxxxxx I INI I I I I I IWI Date Work Began 05/30/2017 Date Work Ended 6/6/2017 Latitude Longitude Local Permit Agency San Joaauin Permit Number SR0077520 Permit Date 5/19/17 APN/TRS/Other Geologic Log Well Owner Orientation O Vertical O Horizontal OAngle Specify Name Sharon Maynihan Drilling Method Direct Rotary Drilling Fluid Fresh Water Mailing Address 29151 Coventry Dr Depth from Surface Description Feet to Feet Describe material grain size,color,etc City Tracy State Ca Zi 0 8 Top Soil Well Location 8 14 Sand Address 8934 W Schulte Rd 14 26 Sand Gravel City Tracy County San Joaquin 26 34 Gravel Latitude N Longitude 34 48 Sand Gravel Dec. Min. Sec. Dea. Min. Sec. 48 64 Clay Gravel Datum Dec-Lat. Dec-Long. 64 70 Clay APN Book Page Parcel 70 92 Clay gravel Township -Range Section 92 116 Clay Location Sketch Activit Sketch must be drawn by ha d after form is printed.) 0 New Well 116 130 Clay sand 130 160 Sand gravel O Deepen n 160 186 Clay sand O Other 186 196 Caly O DDe onrocedures and materials 196 218 Clay sand nnderb pc�oclCLoc- 218 224 Clay Planned Uses 224 236 Clay sand O Water Supply 236 242 j Clay Sand Gravel Domestic El Public ❑ 242 246 Gravel w Irrigation []Industrial O Cathodic Protection 246 254 Clay gravel O Dewatering 254 260 Clay sand gravel O Heat Exchange O Injection O Monitoring 0 Remediation O Sparging SouthO Test Well bit strate or describe distance of well from roads,buildings,fences, 0 Vapor Extraction etc.and attach a map.Use additional paper if necessary. O Other Please be accurate and com lete. Water Level and Yield of Completed Well Depth to first water (Feet below surface) Depth to Static Water Level (Feet) Date Measured Total Depth of Boring 260 Feet Estimated Yield' (GPM) Test Type Total Depth of Completed Well 260 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 0 200 112 Blank PVC Sch.40 SDR 21 6 0 110 Bentonite Grout well DF 200 260 12 Screen PVC Sch.40 SDR 21 6 110 260 Filter Pack Pea Gravel LI I i I -I i I Attachments Certification Statement ❑ Geologic Log I,the undersign ify that this report is complete and accurate to the best of my knowledge and belief ❑ Well Construction Diagram Name Castle ction&Well Drillin on m r orporation ❑ Geophysical Log(s) 1001 S IvaPersn a ite A Modesto CA 95350 ❑ Soil/Water Chemical Analyses dd City State zip ❑ Other Siee 06/10/2017 996768 Attach additional information.if it exists. C-5711ELtnsed Water Well Contractor Date Signed C-57 License Number DWR 188 REV.1/2006 IF ADDITIONAL SPAY IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM