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4 L�J <br /> `The free Adobe Reader may be used to view and complete this form. However,software must be purchased to complete,save,an use a ed 'W <br /> File Original with DWR State of California Not Fill In <br /> Page 1 of 1 Well Completion Report <br /> Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number SGMW-1 No. e0363360 111 , IJNJJw <br /> Date Work Began 01/16/2018 Date Work Ended 1/16/2018 Latitude Longitude <br /> Local Permit Agency San Joaquin County <br /> Permit Number 0037697 Permit Date 12/15/17 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name ASP/RWM Properties,et al <br /> Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address 1200 Concord Ave, STE 200 <br /> Depth from Surface Description Concord CA 94520 <br /> Feet to Feet Describe material, rain size,color,etc Cit State Ip <br /> 0 3 Brown very silty fine sand. Well Location <br /> 3 6 Light brown, less silty. Address 17100 Murphy Parkway <br /> 6 11 Medium brown, more silty. City Lathrop County San Joaquin <br /> 11 15 Less silty. Latitude N Longitude w <br /> Dea. Min. Sec. Dea. Min. Sec. <br /> Datum Decimal Lat. Decimal Long. <br /> APN Book 198 Page 012 Parcel 009 <br /> Township -Range Section <br /> Location Sketch Activit <br /> Sketch must be drawn by hand after form isprinted.) O New Well <br /> North Q Modification/Repair <br /> Q Deepen <br /> O Other <br /> Q Destroy <br /> Describe procedures and materials <br /> under'GEOLOGIC LOG- <br /> Planned Uses <br /> Q Water Supply <br /> [-]Domestic ❑Public <br /> w ❑Irrigation ❑Industrial <br /> Q Cathodic Protection <br /> Q Dewatering <br /> Q Heat Exchange <br /> O Injection <br /> Q Monitoring <br /> Q Remediation <br /> Q Sparging <br /> South Q Test Well <br /> Illustrate or describe distance of well from roads,buildings,fences, O Vapor Extraction <br /> rivers,etcand attach a map.Use additional paper if necessary. Q Other <br /> Please be accurate 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 13 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 12 Feet Test Length (Hours) Total Drawdown (Feet) <br /> *May not be representative of a well's long term yield. <br /> Casings Annular Material <br /> Type Material wall Outside Screen Slot Size Depth from <br /> Depth from Borehole <br /> Surface Diameter Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 5 18 Blank PVC Sch.40 12 0 12 1 Cement <br /> 5 12 8 Screen PVC Sch.40 12 Milled Slots 0.010 2 4 Bentonite <br /> 4 13 Fill 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 Drilling LP <br /> Person,Firm or Corporation <br /> ❑ Geophysical Log(s) 3000 DUluth Street West Sacramento CA 95691 <br /> ❑ Soil/Water Chemical Analyses Address City State Zip <br /> ED Other Signed 2/9/18 938110 <br /> Attach additional information,if it exists. C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> II0q-k� - M3 I. 4fop, c� <br />