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'The free Adobe Reader may be used to view and compa form. However,software must be purchased to complete,land reuse a saved form. <br /> File Original with DWR State of California DWR Use On -Do Not Fill In <br /> Page of Well Completion Report <br /> Refer ro Instruction Pam.Mer State Well Number/Site Number <br /> Owners Well Number AS-1 No. e0254711 <br /> Date Work Began 01/05/2015 Date Work Ended 1/5/2015 Latitude Lon nude <br /> Local Permit Agency San Joaauin county Environmental Health <br /> Permit Number 70983 Permit Date 11/18/14 APN/rRs/other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Speciry 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 7ip 95949 <br /> 0 40 Clay,dense,stiff,light brown Well Location <br /> 40 80 Clays,dense,stiff, darker brown Address 10848 CopperoDDlis Road <br /> 80 120 Semi-silty dense clay mix,stiff clay, dark brown City Stockton County San Joaquin <br /> Latitude N Longitude ______.yN <br /> Dec. Min. Sec. Dec. Min. Sec. <br /> Datuni Dec. Lat Dec.Long. <br /> APN Book Page Parcel <br /> Township -Range Section <br /> Location Sketch Activit <br /> Sketch must be drawn by hand afar form is anted. Q New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> 10 Destroy <br /> nidi pmceEum eM melaiala <br /> uMc'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic El Public <br /> ad da ❑Imgadon ❑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 /> SouthO Test Well <br /> ummamordiddi ni,mncnor+.er rmm mads,Imameanene�, O Vapor Extraction <br /> mams,ne.and adaeh a mapuae addupem Pacer uee<naa,y. O Other <br /> lai beaccuppade and complete. <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 120 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 120 Feet Test Length (Hours)Total Drawdown (Feet) <br /> *May not be representative Die well's longterm yield. <br /> Casings Annular Material <br /> Depth from Borehole Wall Outside Screen Slot Size Deplh 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 /> 0 110 8 Blank PVC SCh 40 2 1 1 0 105 Portland Cement <br /> 110 115 8 Screen PVC Sch 40 2 1 Slot 10.010 105 108 Bentonite Chips <br /> 115 120 8 Blank - Pvc Sch 40 2 108 120 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 Drillino L.P. <br /> ❑ Geophysical Log(s) 3000 Duluth Street Firm or corporation West Sacramento CA 95691 <br /> ❑ Soil(Water Chemical Analyses dares City stale zip <br /> ❑r Other Site Map Signed /Q L Q✓' 02/12/2015 938110 <br /> Attach additional informi if it exis6. -57 licensed Water Well Contra t Date Signed C-57 License Number <br /> DWR 188 REV.112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />