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00 d wand com let orm However software must be purchased to complete, sav reuse a saved form. `The free Adobe Reader may be use o vle p File Original with DWR State of California Page 1 of 1 Well Completion Report Refer to Instruction Pamphlet Owner's Well Number DPE-1 No• e02O7832 Date Work Began 05/07/2012 Date Work Ended 5/7/2012 Local Permit Agency Can oacluin Environmental Health DWR Use Only — Do Not Fill In � State Well Number/Site Number I � E I W Latitude Longitude APN/TRS/Other Permit Number 64847 Permit Date 4/30/12 Well Owner teasmc Depth from Borehole Type Material Surface Diameter Feet to Feet Inches 0 20 10 Blank PVC Sch. 40 20 160 10" 1 Screen I PVC Sch. 40 LJ Geologic Log ❑ Well Construction Diagram ❑ Geophysical Log(s) ❑ Soil/Water Chemical Analyses ❑ Other DWR 188 REV. 1/2006 Jame CA Army National Gaurd Aailing Address 10620 Mather Blvd Well address 8020 S Airport Way -ity Stockton County San Joaquin _atitude N Longitude _yy Dea. Min. Sec. Dea. Min. Sec. Datum Dec. Lat. Dec. Long. APN Book Page Parcel 177-260-04 Sketch IIllustrate or describe distance of —111— ,ad,, buildings, fences, rivers, etc. and attach a map. Use additional paper if necessary. Q New Well Q Modification/Repair Q Deepen O Other Q Destroy Describe procedures and materials under "GEOLOGIC LOG" Planned Uses Q Water Supply ❑ Domestic ❑ Public U.1 []irrigation ❑Industrial Q Cathodic Protection O Dewatering O Heat Exchange 0 Injection 0 Monitoring 0 Remediation 0 Sparging 0 Test Well (E) Vapor Extraction Q Other Water Level and Yield of Completed Well Depth to first water 34 (Feet below surface) Depth to Static Water Level 30 (Feet) Date Measured Estimated Yield ` (GPM) Test Type Test Length (Hours) Total Drawdown (Feet) *May not be representative of a well's long term yield. Annular Material Wall Outside Screen Slot Size Depth from Thickness Diameter Type if Any Surface Fill Description Inches Inches Inches Feet to Feet 0 L13 Cement Grout Milled Slots 0.020 13 Bentonite Seal 18 161 1 Fill Sand Filter pack Certification Statement I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief Name Woodward Drilling Company Inc Person, Firm or Corporation 550 Riv r Road Rio Vista CA 94571 Address Ci State Zip Signed 4/2/2014 710079 C-57 Licensed Wa ell Contractor Date Signed C-57 License Number IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM Geolo is Lci Orientation O Vertical O Horizontal OAngle Specify Drilling Method Hollow Stem Auger Drilling Fluid Bentonite mud Depth from Surface Feet to Feet Description Describe material, grain size, color, etc 0 11 1 Asphalt 1 14 1 Sandy Lean Clay 4 8 1 Change in color to dark yellowish brown 8 110 1 Sandy Clay 9.5 110 Sandy Clay with Gravel 10 14 Sandy Clay 13.4 121 Silty Clay with Sand 21 26 Sand 26 30 Silt with Clay Dark Olive Gray 29.5 31 Change Color to Olive Gray 31 34 Sandy Clay 34 37 Sand 37 49 Sandy Clay 49 52 Well Graded Sand Dark Olive Gray 61.5 54 Change Color to Olive Gray 54 57 Poorly graded course sand 57 61 Clayey Sand Total Depth of Boring 61 Feet Total Depth of Completed Well 60.1 Feet teasmc Depth from Borehole Type Material Surface Diameter Feet to Feet Inches 0 20 10 Blank PVC Sch. 40 20 160 10" 1 Screen I PVC Sch. 40 LJ Geologic Log ❑ Well Construction Diagram ❑ Geophysical Log(s) ❑ Soil/Water Chemical Analyses ❑ Other DWR 188 REV. 1/2006 Jame CA Army National Gaurd Aailing Address 10620 Mather Blvd Well address 8020 S Airport Way -ity Stockton County San Joaquin _atitude N Longitude _yy Dea. Min. Sec. Dea. Min. Sec. Datum Dec. Lat. Dec. Long. APN Book Page Parcel 177-260-04 Sketch IIllustrate or describe distance of —111— ,ad,, buildings, fences, rivers, etc. and attach a map. Use additional paper if necessary. Q New Well Q Modification/Repair Q Deepen O Other Q Destroy Describe procedures and materials under "GEOLOGIC LOG" Planned Uses Q Water Supply ❑ Domestic ❑ Public U.1 []irrigation ❑Industrial Q Cathodic Protection O Dewatering O Heat Exchange 0 Injection 0 Monitoring 0 Remediation 0 Sparging 0 Test Well (E) Vapor Extraction Q Other Water Level and Yield of Completed Well Depth to first water 34 (Feet below surface) Depth to Static Water Level 30 (Feet) Date Measured Estimated Yield ` (GPM) Test Type Test Length (Hours) Total Drawdown (Feet) *May not be representative of a well's long term yield. Annular Material Wall Outside Screen Slot Size Depth from Thickness Diameter Type if Any Surface Fill Description Inches Inches Inches Feet to Feet 0 L13 Cement Grout Milled Slots 0.020 13 Bentonite Seal 18 161 1 Fill Sand Filter pack Certification Statement I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief Name Woodward Drilling Company Inc Person, Firm or Corporation 550 Riv r Road Rio Vista CA 94571 Address Ci State Zip Signed 4/2/2014 710079 C-57 Licensed Wa ell Contractor Date Signed C-57 License Number IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM