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-The free Adobe Reader may be used to New and complete this forth. Ho in er,aanware must be purchased to complete,save.and reuse a saved forth. <br /> File Original with DWR Slate of California DWR Use Only-Do Not FG In <br /> Page 1 of 1 Well Completion Report <br /> Rererfs rnixrucxlsn Aemphler State Well Number/Site Number <br /> Owner's Well Number No. e0324832 [�m <br /> Date Work Began 09/0112016 Date Work Ended 9!2312016 Latitude Lon Itude <br /> Local Permit Agency San Joaauin County Environmental Health IJent. <br /> Permit Number SR0075555 _ Permit Date 8115116 APN1TRSfOther <br /> Geologic Log Well Owner <br /> Orientation OVertcal 0Horizontal OAngle SPecity Name Geadd and Roberta Martin <br /> Orllling Method Mud Rotary Drilling Fluid water MaMng Address 27927 Vine Ave <br /> Depth from Surface Description City Escalon State C—A Zi 95320 <br /> Feel to Feet Describe material grain size color,etc <br /> 04 To Soil Well Location <br /> 4 11 Clay Address 27927 Vine Ave <br /> 11 130 Sand City Escalon County San Joaquin <br /> 30 138 Clay Latitude N Longitude__Ja <br /> 38 160 Small Gravel and course sand Den. Min. Sec, Dee. Min. Sac <br /> 60 1125 Sand Datum Dec.Lat. Dec.Long. <br /> 125 J128 Clay APN Book 249 Page 030 Parcel 08 <br /> 128 1140 Sand I Township Ranne Section <br /> 140 1144 Clay _ Location Sketch Activity <br /> Sketch must bsdrs b hmdahrrrorm is mea. (j) New Well <br /> 144 154 Sand Nadh O ModificalionlRepair <br /> 154 162 Clay with shale ODeepen <br /> MY 162 167 Sand t 2016 OOther <br /> 167 174 Cie with shale O Destroy0 <br /> 174 186 Sand Elm <br /> IbIE T wee.cao[.ocic xnc• <br /> 186 190 Clay with shale rtKM1T/SERIlqrrR <br /> Planned Uses <br /> 190 194 Sand O Water Supply <br /> ❑i Domestic ❑PUblic <br /> 194 1204 Clay with shale 3 ❑Irrigation ❑Industrial <br /> 204 214 Sand O Cathodic Protection <br /> 214 244 Clay O Dewatering <br /> 244 246 Sand O Heat Exchange <br /> 246 255 Clay with shale O Injection <br /> 255 262 Sand O Monitoring <br /> 262 265 Clay O Remediation <br /> 265 285 Sand O Sparging <br /> O Test Well <br /> 285 290 Clay South O Vapor Extraction <br /> [curWla wpleat�Ea delvm ev henmane.b�dab�pr,kwa. <br /> d,nm,scene aaadi.m+n u.n memenaxraaa„rr.omw OOther— <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level 105 (Feet) Date Measured <br /> Total Depth of Faring 290 Feet Esgmated Yield' (GPM) Test Type <br /> Test Length (Hours) Total Drawdown_(Feet) <br /> Total Depth of Completed Weil 285 Feet -Manot be re resentative of a welds long term yield. <br /> Casins Annular Material <br /> Depth from Borehole Type Matadal Wall Outside Screen Slot Size Depth From <br /> Surface Diameter Thlnknase Diameter Type If Any Surface Fill Description <br /> Feel ra Feet Inches Inches Inchea Inches Feet m Feet <br /> 0 255 14 Flank PVC .322 8 0 125 Dantonite Quik Grout <br /> 255 285 114 1 Perforated PVC .322 8 10.050 125 285 1 filter pack No.6 Sand pack <br /> AttachmentsCertification Statement <br /> ❑Geologic Log I,the understped,cargfy that this report Is7plele and accurate to the best of my knowledge and Delle( <br /> ❑Well Construction Diagram Name Henmm�S Bros Drilling Co Inc <br /> g Perwa,Flan or Corysradan <br /> ❑Geophysical Logs) 1930 Ladd Rd Mo es to CA 95356 <br /> ElSoil/Water Chemical Analyses Aadreu ary mill as <br /> El Other Signed 09-30-16 290813 <br /> AMdi addi9xmei infaenedm lr It estate. osrumneed Wal9,WCICanaador Date Signed G57 License Number <br /> Own 189 REV.12000 IF ADDITIONAL SPACE IS NEEDED.USE NEXT CONSECUTIVELY NUMBERED FORM <br />