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'The free Adobe Reader may be used m view and complete this form. However,software must be purchased to complete,save,and reuse a saved form. <br /> Pile Original with DM State of California DWR Use Only-.DoNotFit In <br /> Page 1 of 1 Well Completion Report <br /> Owner's Well Number 2015-1 <br /> No t°002859 <br /> � State Well NumbedSire Number <br /> 58 <br /> let—I <br /> Dale Work Began 09/2812015 Date Work Ended-1012112015 Latitude Longitude <br /> Local Permit Agency San Joaouin Fnvironm ental Health Department <br /> Permit Number_SR00725524 Permit Date 6/24/15 IAPN/TRS/Other <br /> Geotogw Log well owner <br /> Orientation t7 Vertical 0 Horizontal OAngle Specify <br /> Drilling Mentod Drilling Fluid Name Kusaiakan ration <br /> CgrAO <br /> Dosedpition Mailing Address 40174 S pad Ct. <br /> DeFeet to Few pth from Surface Describe material,arain size,color.etc Cit y Freemont StateCA__Zip 94538 <br /> 0 15 Fine&medium li ht brown sand. well Location <br /> 15 20 Fine&medium sand with some cia stone Address 9698 S.Priest Rd. <br /> 20 37 Fine&medium sand wl some ciaystone, City French Camp County San Joaquin <br /> Multi-Chlor&Pyrite. Latitude N Longitude w <br /> 37 150 Li ht brwn clay w/med.&coarse sands multi-color Dec ;in 77 om mm sec <br /> 50 68 Creamy white clay w/sands Datum Dec.Lai. 37.870436 Dec.Long.-121.266374 <br /> 68 80 Superfine sand wl light brwn..clay&coarse sand APN Book 193 Page 220 Parcel 15 <br /> 80 96 Med.&fine sand multi-colors Townshi Ra a Section <br /> 96 185 Clay w/multi-colored sands Location Sketch Activity <br /> 185 200 Clay&fine sand Skean must to drawn by nand after form Is New Well <br /> North OModification/Repair <br /> 200 230 Medium sand multi-colors O Deepen <br /> 230 245 1 Medium sand multi-colors w/small ravel O other <br /> 245 267 Slue shale w/small gravels O Destroy <br /> 0—b. " <br /> 267 270 Sandy blue shale clay w/medium sands tuwler'6EOWGIC LOG' <br /> 270 285 Fine shale sand w/med,multi-colored sands Planned Uses <br /> 285 300 Blue Shale like cla 0 Water Supply <br /> (Q Domestic ❑Public <br /> ❑irrigation ❑industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> 0 Heat Exchange <br /> O lnjection <br /> O Monitoring <br /> OCT 22 2015 O Remediation <br /> O Sparging <br /> South O/0 Test Well <br /> Nhuvatn w aoscnoe disw,cu of-Ya ken roses,bwuAnes,imus. Vapor Extraction <br /> ane acscn A map,U"eda b.-w P.P.if naceonuY. O Other <br /> — Watter Level and Yield of Corn~Well <br /> Depth to first water (Feet below surface) <br /> — Depth to Static <br /> II&tter Level 32 (Feet) Date Measured 10/0212015 <br /> Total Depth of Boring 300 Feet Estimated Yield' 40 (GPM) Test Type Air Lift <br /> Total Depth of Completed Well 300 Feet Test Length 1.0 (Hours) Total Drawdown 60 (Feet) <br /> *May not be representative of a well's long term L02i-- <br /> Casings Annular Material <br /> Depth from BonWx" Wail Outside Screen Sint size Depth from <br /> Surface Diarnatar Type Material Thickness Diameter Type If Any Surface Fill Description <br /> Feet to Feel 'inches Inches) inches Inches Feet to Feet <br /> 0 1230 11 SDR-17 Pvc 1.327 5.563 I Blank 1 0 212 Grout Sand/Slurry <br /> 230 1250 11 SOR-17 jPVC 1.327 15.563 1 Screen OA32 212 300 Sand #8 <br /> 250 f270 11 sort•17 PVC 327 5.563 Blank <br /> 270 290 11 snR-17 PVC .327 5.563 screen 0.032 <br /> 290 300 11 SDR•17 jPVC 327 5.563 1 Blank <br /> Attachments Certification Statement <br /> ❑Geologic Log 1,the undersigned,cert f�yy that this report is complete and accurate to the best of my knowledge and belief <br /> D Well Construction Diagram Name Martell Water Systems Inc <br /> ❑ <br /> Geophysical L Parson,Firm or Corpolaion <br /> Log(s) 1 1 L v ri u CA 94565 <br /> ❑SoiUWater Chemical Analyses Aidross Cny Slate Zp <br /> ❑Other Signed <br /> Araataamt«+al,mmnaia c,ie" C-57 sedwaWwwlcomractor Date Signed C-57 License Number <br /> DVOR 1S9 REV,112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVEI.Y NUMBERED FORM <br />