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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 Onl - Do Not Fill In Page 1 of 1 Well Completion Report Well Location 1 3 Sandy Gravel Owner's Well Number FMS - MW7 Refer to Instruction Pamphlet No. e0203298 State Well Number/Site Number Date Work Began 03/07/2013 9 Date Work Ended 3/7/2013 N w Local Permit Agency San Joaguin Environmental Health Latitude Longitude Location Sketch Sketch must be drawn by hand after form is rinted. Permit Number Permit Date 1/24/13 APN/TRS/Other Geologic Log Well Owner Orientation O Vertical O Horizontal OAngle Specify Drilling Method Hollow Stem Auger Drilling Fluid Depth from Surface Description Feet to Feet Describe material, grain size, color, etc Name _CA Army National Gaurd Mailing Address 10620 Mather Blvd City Mather State _CA__Zip 95655 0 1 Asphalt Well Location 1 3 Sandy Gravel Address 8020 S Airport Way City Stockton County San Joaquin Latitude N Longitude Dea. Min. Sec. Dec. Min. Sec. Datum Dec. Lat. Dec. Long. APN Book Page Parcel 177-260-04 Townshi Range Section 3 12 Sandy Silt 11.5 13 Well Graded Sand 12.5 18 Sandy Silty Clay 17.5 22 Silty fine sand with clay 22 23 Poorly Graded coarse sand 22.5 24 Sandy Clay 24 30 Poorly Graded coarse sand Location Sketch Sketch must be drawn by hand after form is rinted. Activity 30 32 Silty Clay with Fine Sand Qi New Well O Modification/Repair Deepen O Other Q Destroy Describe procedures and materials under "GEOLOGIC LOG" 32 34 Fine sand with silt North ca LU South 33.5 35 PoorlyO graded coarse sand 35 39 Silty fine sand 38.5 45 Silty clay with fine sand 45 48 Well graded sand with clay Planned Uses 48 51 Sandy Clay Q Water Supply ❑ Domestic ❑ Public ❑ Irrigation ❑ Industrial O Cathodic Protection O Dewatering O Heat Exchange O Injection 0 Monitoring O Remediation O Sparging O Test Well O Vapor Extraction O Other Illustrate or describe distance of well from roads, buildings, fences, rivers, etc. and attach a map. Use additional paper if necessary. Please be accurate and complete, Water Level and Yield of Completed Well Depth to first water 33 (Feet below surface) Depth to Static Water Level (Feet) Date Measured Estimated Yield * (GPM) Test Type Test Length (Hours) Total Drawdown (Feet) May not be re resentative of a well's long term yield. Total Depth of Boring 51 Feet Total Depth of Completed Well 50 Feet Casings Depth from Borehole Wall Outside Screen Slot Size Surface Diameter Type Material Thickness Diameter Type if Any Feet to Feet Inches Inches Inches Inches 0 25 8" Blank PVC Sch. 40 Annular Material Depth from Surface Fill Description Feet to Feet 0 118 1 Cement Grout 25 50 8" Screen PVC Sch. 40 Milled Slots 0.020 18 123 1 Bentonite Bentonite 23 50 Fill Sand 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 Woodward Drilling Comoanv. Inc ❑ Geophysical Log(s) Person, Firm or Corporation 550 River Road Rio Vista CA 94571 ❑ Soil/Water Chemical Analyses Address ity State zip ❑ Other Signed 2/26/14 710079 Attach additional information if it exists. C-57 Licensed Wa r ell Contractor Date Signed C-57 License Number DWR 188 REV. 1/2006 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM