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'The free Adobe Reader maybe used to view and complete this form. However, software must be purchased to complete, save, and muse a saved form. <br />File Original with DWR State of California <br />Page of Well Completion Report <br />Refer to 1� Pemphlel <br />Owner's Well Number DW -2 No. e0087198 <br />Date Work Began 02/04/2009 Date Work Ended 2/4/2009 <br />Local Permit Agency San Joaquin Count <br />Permit Number SR#56353 Permit Date 122109 <br />DWR Use Only -Do Not Fill In <br />Stale Well Number/Site Number <br />Labbift Longitude <br />APN/R2SKKher <br />Geologic Log <br />Well Owner <br />Orientation OVertical 0Horizontal <br />Drilling Method Hollow Stem Auger <br />OAngla SpacdY <br />Drilling Fluid <br />Name Guido Segerini <br />Mailing Address P.O. Box 1810 <br />C ity State CA Zi 95801 <br />Depth from Bu Description <br />Feet to Feetet Describe material, rain sae color, etc <br />o 5o Conductor casing steel <br />Well Location <br />5o 75 Sands silt semi brown <br />Address 75 East Alpine Ave <br />75 84 Silty sands hit brown clay <br />City Stockton County San Joaquin <br />Latitude N Longitude __---_N <br />[)eq . Min. Sec, Den, Min, Sec. <br />Daturi Decimal Let. Decimal Long. <br />APN Book Page Parcel <br />Township Range Section <br />Location Sketch <br />form is Anted) <br />Activit <br />(Sketch must Ge drawn by hand aver <br />North <br />O New Well <br />O ModficationlRepair <br />4 m <br />S w <br />South <br />O Deepen <br />0Other <br />p Destroy <br />oescrae Pdde i, and malcd.h <br />uM V GEXGGC LCG' <br />Planned Uses <br />O Water Supply <br />E] Domestic ❑Public <br />❑Irrigation ❑Industrial <br />O Cathodic Protection <br />O Dewatering <br />O Heat Exchange <br />O Injection <br />O Monitoring <br />O Remediation <br />O Sparging <br />O Test Well <br />O Vapor Extraction <br />0Other <br />nasvae mae:cme agoda dfw<e rmm roads.Iunlddaz.lmcss, <br />vsa, nc..ed.dnha�ren-use.d0d 1wwrnnece::ay. <br />Naee be accurara aria cont me. <br />Water Level and Yield of Completed <br />Well <br />Depth to first water 20 (Feet below surface) <br />Depth to Static <br />Water Level 20 (Feet) Date Measured 02/04/2009 <br />Estimated Yield(GPM) Test Type <br />Test Length (Hours) Total Drawdown (Feet) <br />Way not be representative of a well's Ion term yield. <br />Total Depth of Boring <br />Total Depth of Completed Well 84 <br />Feet <br />Feet <br />Casings <br />I Annular. Material <br />Depth from Borehole <br />Surface Diameter TyPa <br />Feet w Feet Inches <br />Material Wall Outside Screen Slot Size <br />Thickness Diameter Type if Any <br />Inches Inches Inches <br />Depth from <br />Surface Fill Description <br />Feet to Feet <br />0 73 8 1 Pvc PVC <br />Sch 02 <br />0 71 Cement <br />73 84 g PVC PVC <br />Sch 40 2 Slot 0.010 <br />71 173 Bantonae <br />73 84 Fill Sand #2112 <br />Attachments <br />Certification <br />Statement <br />❑ Geologic Log <br />❑ Well Construction Diagram <br />❑ Geophysical Logs) <br />❑ Soil/Water Chemical Analyses <br />❑+ Other Site maD <br />Amaro mdiaonal inPonnaudn titadsh. <br />I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief <br />Name Cascade Drillina Inc' <br />Person, Firm acap.bon <br />3632 O ec jrG Rancho Cordova CA 9742 <br />Aa Ony Smte rip <br />Signed - 21232009 717510 <br />G5l luense vyaoer II Cariaei Date Signed C-57 License Number <br />DWR 188 REV. 17006 1F ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />