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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 reuse a saved form. <br />File Original with DWR <br />State of California <br />Well Completion Report <br />Page of <br />Rerer bi laxein Pem(NIN <br />Owner's Well Number DW -3 <br />No. e0087199 <br />Date Work Began 02/04/2009 <br />Date Work Ended 2/4/2009 <br />Local Permit Agency San JoaDuin County <br />Permit Number SR#56353 <br />Permit Date 1/22/09 <br />DWR Use Only — Do Not Fill In <br />State Well Number/Sae Number <br />Latitude Lo ' <br />APNlTRS/Otber <br />Orientation OVertical 0Horizontal 0Angle Specify Name Guido Senerini <br />Drilling Method Ho11ow Stem Auger Drilling Fluid <br />Depth from Surface Description Mailing Address P.O. BOX 1810 <br />Feet to Feet Describe material, grain size, color, etc City ADtos State CA yip 95801 <br />0 50 Conductor casing steel Well Location <br />50 75 Sands silt semi brown Address 75 East Aloine Ave <br />75 84 Silty sands hit brown clay City Stockton County San Joaquin <br />Latitude N Longitude _ _ <br />Dee Min. Sec. Dec. Min. Sec. <br />Datum Decimal Lat. Decimal Long. <br />APN Book Page Parcel <br />Total Depth of Boring <br />Total Depth of Completed Well <br />m di, rt, aname proven nom ­& bmnmas,><nas, <br />.. snd vftnh a map. u:e aaaionai pacer iloeceszvy. <br />0 <br />New Well <br />Modification/Repair <br />0 Deepen <br />end mmmis <br />0 Water Supply <br />E] Domestic El 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 />0 Vapor Extraction <br />0 Other <br />Depth to first water 20 (Feet below surface) <br />Depth to Static <br />Water Level 20 (Feet) Date Measured 02104/2009 <br />Feet Estimated Yield(GPM) Test Type <br />Test Length (Hours) Total Drawdown _(Feet) <br />Feet *Mev net be representative of a well's Iona term yield. <br />Depm from Type e Material wall Outside Screen Slot Size Depth from <br />Sunc�e Diameter Thickness Diameter Type If Any Surface Fill Description <br />nochoet flnchesl 11 Feet to Feel <br />073 8 PVC <br />P <br />V <br />C <br />acn 4u Z <br />73 84 8 PVC PVC SCh 40 2 Slot 0.010 71 73 Bentonite <br />73 1 Rd I Fel I Sand #2/12 <br />❑ Geologic Log I, the undersigned, certify that this report is complete and accurate to the best or my Knowleege and Defier <br />❑ Well Construction Diagram Name Cascade DrillinC Inc <br />Parson, Firm a Cor onibon <br />❑ Geophysical Log(s) 3632 Ot t c irc Rancho Cordova CA 9742 <br />❑ SoillWater Chemical Analyses d' City Site Zip <br />❑+ Other Site may) Stoned 21232009 717510 <br />atNm adanimal intorma6on Knexlats c57 Umise waK+wea Corlaecbr Date Signed CS7 License Number <br />DWR 188 REV. Woes IF ADDITIONAL SPACE IS NEEDED, USE NM CONSECUTIVELY NUMBERED FORM <br />