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'The free Adobe Reader may be 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 State of California DWR Use Only-Do Not Fill In <br /> 1 of 1 Well Completion Report <br /> Page InstructionPamphlet <br /> State Well Number/Site Number <br /> Owner's Well Number SGMW-2 No. <br /> e0363361 I I I N I I I I I I I IWI <br /> Date Work Began 01/16/2018 Date Work Ended 1/16/2018 Latitude Longitude <br /> Local Permit Agency San Joaauin County <br /> Permit Number 0037697 Permit Date 12/15/17 APNITRS/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 <br /> Mailing Address 1200 Concord Ave,STE 200 <br /> Depth from Surface Description <br /> Feet to Feet Describe material,grain size,color,etc City Concord State CA Zip 94520 <br /> 0 5 Dark brown very silty fine sand. Well Location <br /> 5 10 Medium brown, less silty. Address 17100 Murphy Parkway <br /> City Lathrop County San Joaquin <br /> Latitude N Longitude W <br /> Dec. 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 is printed. Q. New Well <br /> North Q Modification/Repair <br /> O Deepen <br /> O Other <br /> Q Destroy <br /> Describe procedures and materials <br /> under'GEOLOGIC LOG' <br /> Planned Uses <br /> 0 Water Supply <br /> ❑Domestic [-]Public <br /> M ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> Sparging <br /> South O Test Well <br /> Illustrate or describe distance of well from mads,buildings,fences, Vapor Extraction <br /> rivers.etc.and attach a map.Use additional paper if necessary O 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 10 Feet Estimated Yield* (GPM) Test Type <br /> Total Depth of Completed Well 10 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 3 8 Blank PVC Sch.40 12 0 1 Cement <br /> 3 10 8 Screen PVC Sch.40 2 Milled Slots 0.010 1 2 Bentonite <br /> 2 10 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 Lo <br /> 9(S) 3000 Duluth Street West Sacramento CA 95691 <br /> ❑ Soil/Water Chemical Analyses Address City State Zip <br /> 0 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.12006 IF ADDITIONAL SPACE IS NEEDED.USE NEXT CONSECUTIVELY NUMBERED FORM <br />