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`The free Adobe Reader may be used to view and completaform. However, software must be purchased to complete, sa d reuse a saved form. <br />File Original with DWR State of California <br />Well Completion Report <br />Page 1 Of 1 Refer to Instruction Pamphlet <br />Owner's Well Number DPE-2 No. e02O7839 <br />Date Work Began 05/08/2012 Date Work Ended 5/8/2012 <br />Local Permit Agency San Joaauin Environmental Health <br />Permit Number 64847 Permit Date 4/30/12 <br />DWR Use Only — Do Not Fill In <br />State Well Number/Site Number <br />"' I I II II W <br />Latitude Longitude <br />APN/TRS/Other <br />Well Owner <br />Geologic Log <br />Orientation O Vertical O Horizontal OAngle Specify <br />Drilling Method Hollow Stem Auger Drilling Fluid Bentonite mud <br />Name CA Army National Gaurd <br />Mailing Address 10620 Mather Blvd <br />Cit Mather State CA 7i 95655 <br />Depth from Surface Description <br />Feet to Feet Describe material, rain size, color, etc <br />0 1 Asphalt <br />Well Location <br />1 3 Sandy Lean Clay <br />Address 8020 S Airoort Way <br />City Stockton County San Joaquin <br />Latitude N Longitude ____Yy <br />Deo. Min. Sec. Dea. Min. Sec. <br />Datum Dec. Lat. Dec. Long. <br />APN Book Page Parcel 177-260-04 <br />1 Township -Range Section <br />2.5 8 Sandy Clay <br />8 12 Silty clay with Sand <br />12 21 Sandy Silt <br />21 27 Well Graded Sand <br />26.5 29 Silty Clay Very Dark Grayish brown <br />28.5 31 Color is dark yellowish brown <br />31 34 Silty Clay <br />Location Sketch <br />Sketch must be drawn hand d after form is tinted. <br />Activit <br />33.5 38 Clayey Sand <br />Qi New Well <br />O <br />0 Deepen n <br />p <br />O Other <br />O DDesscribee procedures and materials <br />under-GEOLOGICLOG' <br />N <br />38 43 Sandy Silt <br />3 w <br />South <br />42.5 48 Silty Clay <br />48 51 Clayey Sand <br />51 52 Clay <br />Planned Uses <br />52 61 Poorly Graded Coarse sand <br />0 Water Supply <br />❑Domestic ❑Public <br />❑ Irrigation ❑ Industrial <br />0 Cathodic Protection <br />0 Dewatering <br />0 Heat Exchange <br />0 Injection <br />0 Monitoring <br />0 Remediation <br />0 Sparging <br />0 Test Well <br />O Vapor Extraction <br />O Other <br />cof well from roads, buildings, fences, <br />rivers, etc. and attach a mp. Use additional paper if necessary. <br />Illustrate or describe dista:coe <br />Please be accurate and m late. <br />Water Level and Yield of Completed Well <br />Depth to first water 34 (Feet below surface) <br />Depth to Static <br />Water Level 30 (Feet) Date Measured <br />Estimated Yield ' (GPM) Test Type <br />Test Length (Hours) Total Drawdown (Feet) <br />*May not be representative of a well's long term yield. <br />Total Depth of Boring 61 Feet <br />Total Depth of Completed Well 58.7 Feet <br />Casings <br />Annular Material <br />Depth from Borehole Wall Outside Screen Slot Size <br />Surface Diameter Type Material Thickness Diameter Type if Any <br />Feet to Feet Inches Inches Inches Inches <br />Depth from <br />Surface Fill Description <br />Feet to Feet <br />0 24 10" Blank PVC Sch. 40 <br />0 17 Cement Grout <br />24 59 10" Screen PVC Sch. 40 Milled Slots 0.020 <br />17 22 Bentonite Seal <br />22 61 Fill Sand Filter pack <br />Attachments <br />Certification Statement <br />❑ Geologic Log <br />❑ Well Construction Diagram <br />❑ Geophysical LO g(S) <br />❑ Soil/Water Chemical Analyses <br />❑ Other <br />Attach additional information if it exists. <br />I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief <br />Name Woodward Drillina Company Inc. <br />Person, Firm or Corporation <br />550 River Road Rio Vista CA 94571 <br />Address /w � City State zip <br />Signed lX4/2/2014 710079 <br />C-57 Licensed at r Well Contractor Date Signed C-57 License Number <br />DWR 188 REV. 1/2006 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />