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s <br /> `The free Adobe Reader may be used to view and comps form. However,software must be purchased to complete,ser d reuse a saved form. <br /> File Original with DWR State of California DWR Use Only—Do Not Fill In <br /> Well Completion Report <br /> Page Of Refer to Instruction Pamphlet Slate Well Number/Site Number <br /> Owner's Well Number VW-1 No. e0254710 N <br /> Date Work Began 01/08/2015 Date Work Ended 1/8/2015 atitude Lon nude <br /> Local Permit Agency San Joaeuin county Environmental Health <br /> Permit Number 70983 Permit Date 11/18/14 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name The Source Group <br /> Drilling Method Auger Drilling Fluid <br /> Mailing Address 944 McCourtney Road Suite H <br /> Depth from Surface Description <br /> Feet - to Feet Describe material,grain size,color,etc ` City Grass Valley State CA_Zip 95949 <br /> 0 40 Clay, dense,stiff, dry,light brown Well Location <br /> 40 60 Clays,dense,stiff,dry,change to darker brown Address 10848 Cooperopolis Road <br /> City Stockton County San Joaquin <br /> Latitude N Longitude —FT- <br /> Di Min. Sec. Dao. Min. Sec, <br /> Datum Dec.Lata Dec. Long. <br /> APN Book Page. Parcel <br /> Townshi Ran a Section <br /> Location Skech Activit <br /> Sketch must be drawn b hand aft r form is rented. Q. New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> — <br /> 0 Destroy <br /> sercdbep,c,whe s elma,edela <br /> .wJ=E0UX3lC L00' <br /> Planned Uses <br /> FEB 17 2015 O Water Supply <br /> ❑Domestic El Public <br /> EWRIONMEMtHEALTH3 w ❑Irrigation El Industrial <br /> PERMIll'il'i CES O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O' Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> Inusba,eordecebedolanm of well from roads,bmum �og,gs.re0 Vapor Extraction <br /> .e,e.m,da,lamamep.meoddae�alP,ra,eo>seeir, 0Other <br /> of e..be <br /> zeevrm eed teen ma. <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 60 Feet Estimated Yield` (GPM) Test Type <br /> Total Depth of Completed Well 60 Feet Test Length (Hours)Total Drawdown (Feet) <br /> *May not be representative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Type if Any Surface Fill Description <br /> Feel to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 30 6 I Blank IPVC I Sch 40 12 0 25 Portland Cement <br /> 30 60 8 Screen PVC Sch 40 2 SI01.010 25 28 Bentonite Chips <br /> 28 60 Sand 2/12 <br /> Attachments Certification Statement <br /> ❑Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name Cascade Drill mcl L P <br /> Person,Firm or Corporation <br /> ❑ Geophysical Logs) 3000 Duluth Street West Sacramento CA 95691 <br /> ❑ Sail/Water Chemical Analyses ,,,IAddre _ cry Slate zm <br /> ❑+ Other Site Mal) Signed , �� v 02/12/2015 938110 <br /> Attach additional information.it a exiaLs. s7 Ucen atery ontiaclor Date Signed C-57 License Number <br /> DWR 188 REV.12006 IF ADDITIONAL SPACE 15 NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />