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'The free Adobe Reader maybe used to view and complete this form, However,seftvare must be purchased to complete,save,and reuse a saved form. <br /> File Original with DWR State of California DWR Jg9 oiil M Nptful_In <br /> Well Completion Report t_1 ►-'-;moi? <br /> Page 1 of 1 ReW to MsWcllon PampAlef St tow l NumbedS1 Number <br /> Owner's Well Number No, >� "% `a t U N <br /> Date Work Began 02/14/2017 Date Work Ended 2/16/2017 Ir �L Latitude _ ongltude <br /> Local Permit Agency San Inanuin County EL _ <br /> Permit Number SR0076710 Permit Date 1/31117 APNfTRS/Other <br /> Geo o c Lo" <br /> Orientation O Vertical O Horizontal OAngle Specify _ <br /> Drilling Method Direct Rotary Doling Fluid Fresh Water <br /> Depth Rom Surfaiab Description <br /> Feel to Feat .Pe3crl.fta.:insterlal grain size color,etc _ <br /> 0 10 Top Sol _ W611 LOCOon: <br /> 10 18 Sand Address Same <br /> 18 36 Sand/Clay City County San Joaquin <br /> 36 55 Clay _ _ Latitude N Longitude <br /> 55 68 Sand Doo Mtn. Sec. Ce.. Min, Se, <br /> 68 75 Sand/Clay Datum Dec.Lat. Dec.Long. <br /> 75 98 Sand APN Book Page Parcel <br /> 98 118 Clay Townshi _Range Section <br /> 118 1150 Sand/Clay Location Sketch Activif <br /> mtch qiusibediewn rhand Oar fvmIsPonied.), . New if <br /> 150 170 Clay North 0 Moditicatlon/Repair <br /> 170 175 Sand/Clay _ O Deepen <br /> 175 200 Clay/Gravel O Other <br /> — <br /> 0 Destroy <br /> «•ule• LOGIra•G'awl•r�l� <br /> vM•r'GEOLOOIC LOG' <br /> _--- Aldnne 'Uses <br /> @ Water Supply <br /> E]Domestic ❑Public <br /> U ❑Irrigatlon ❑Industrial <br /> 5 w <br /> ( Cathodic Protection <br /> 0 Dewatering <br /> 0 Heat Exchange <br /> - 0 Injection <br /> 0 Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> O Test Well <br /> South Q Vapor Extraction <br /> IMa Y•I.ae�.rne•ee�n:.we o-a.,,.•.a..burs as.la.r• Other <br /> &—ale.I'd•tLtl,•map.Lf—dM-1 pays a nee—". 11 Q, <br /> Plan.6••scant•ud eom Hb. <br /> ate (eve►and eld of Com Wod ell <br /> Depth to first water 59 (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> 30 (GPM) Tost Type <br /> Total Depth of Boring 200 Feet Estimated Yield' <br /> Test Length (Hours) Total Drawdown (Feet) <br /> Total Depth of Completed Well 200 Feet *Mav not be re resentative of a welt's Ion term yieJd. <br /> . _ . . Casin s Atiut�t�R Mater a _ <br /> Depth from Borehole Type Material Wall Outelde Screen Slot Size Depth from Descrl tion <br /> Surface Diameter Thickness Diameter Type If Any Surface Fill <br /> P <br /> Feet to Feet Inches Inches _ Inches inches Feet to Feet <br /> 0 140 12 Blank PVC Sch.40 <br /> g 0 113 t ntonite Grout Well DF <br /> 140 200 12 Scroen PVC Sch.ao 6 <br /> 0.032 113 200 Filter Pack Pea Gravel <br /> - I <br /> Ce. G814ii State ent <br /> a.chta t.. <br /> ❑Geologic Log I,the undersigne a '(y that this report is complete and accurate to the best of my knowledge and belief <br /> Name le o t t ell Dril"— <br /> ❑Well Construction Diagram Pers R or orperauw CA 9S- 4 <br /> ❑Geophysical Log(s) 1 Modesto <br /> City State Zip <br /> [ISoll/Water Chemical Analyses re <br /> El Other Signed 0211612017 996768 <br /> Auer edau ail Int at on If n edea. ce L n e; wate well Date Signed C-57 License Number <br /> kBEREU FORM <br /> DWR 168 REV 112006 IF ADCITIONAL S E IS NEEDED,USE NEXT CONSECUTIVELY NU <br />