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'The free Adobe Reader may be used to view and complete mr. However, software must be purchased to complete, sa reuse a saved form. File Original with DWR State of California Well Completion Report Page 1 of 1 Refer to Instruction Pamphlet Owner's Well Number AS1A / AS1 B No. e02O7841 Date Work Began 05/09/2012 Date Work Ended 5/9/2012 Local Permit Agency San Joaquin Environmental Health Permit Number 64847 Permit Date 4/30/12 DWR Use Only — Do Not Fill In State Well Number�/Site Numberte T77N]I 1W Latitude Longitude APN/TRS/Other Geologic Log Well Owner Orientation O Vertical O Horizontal OAngle Specify Drilling Method Hollow Stem Au er Drilling Fluid Bentonite mud Name CA Army National Gaurd Mailing Address 10620 Mather Blvd Mather CA 95655 Cit State I Depth from Surface Description Feet to Feet Describe material, rain size, color, etc 0 1 Asphalt Well Location 1 4 Sandy lean clay Address 8020 S Airport Way City Stockton County San Joaquin Latitude N Longitude �N Dea. Min. Sec. Dec. Min. Sec. Datum Dec. Lat. Dec. Long. APN Book Page Parcel 177-260-04 Township -Range Section 4 10 Sandy clay 10 15 Change Color to dark yellowish brown 14.5 21 Sandy Clay 21 27 Poorly graded sand with clay 27 30 Poorly graded sand 30 34 Sandy Clay 34 38 Clayey Sand Location Sketch Sketch must be drawn b hand after form is anted. Activity 38 40 Lean Clay Light Olive O New Well O Modification/Repair O Deepen O Other O Destroy Describe procedures and materials under"GEOLOGIC LOG" North 40 44 Lean Clay Change Color to olive brown LU South 44 47 Change molted olive brown 46.5 53 Change to clayey Sand 9 Y Y 52.5 58 Clay Thick Olive Brown 57.5 69 Well Graded Sand Planned Uses O Water Supply []Domestic ❑Public []Irrigation ❑ Industrial O Cathodic Protection O Dewatering O Heat Exchange O Injection O Monitoring O Remediation O Sparging O Test Well O Vapor Extraction O Other Illushate 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 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. Total Depth of Boring 69 Feet Total Depth of Completed Well 68 / 41 Feet Casings Annular Material Depth from Borehole Type Material Wall Outside Screen Slot Size Surface Diameter Thickness Diameter Type if Any Feet to Feet Inches Inches Inches Inches 11 Depth from Surface Fill Description Feet to Feet 0 64 10" Blank PVC Sch. 80 0 131 1 Cement Grout 64 66 10" Screen PVC Sch. 80 Milled Slots 0.020 31 36 Bentonite Seal 66 68 10" Blank PVC Sch. so 36 42 Fill Sand Filter pack 0 37 10" Blank PVC Sch. 80 42 63 Bentonite Seal 37 39 101r Screen PVC Sch. 80 Milled Slots 0.020 63 69 Fill Sand 39 41 10" Blank PVC Sch. 80 Attachments Certification Statement ❑ Geologic Log ❑ Well Construction Diagram ❑ Geophysical Lo g(S) ❑ Soil/Water Chemical Analyses ❑ Other Attach additional information if it exists. 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, Finn or Corporation 550 River Road Rio Vista CA 94571 Address nCity State zip Signed Lvn a (-,e� l 4/2/2014 710079 C-57 Licensed Wa6^eII Contractor Date Signed C-57 License Number DWR 188 REV. 1/2006 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM