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1 <br /> e <br /> `The free Adobe Reader may be used to view and comIs form. However,software must be purchased to complete, and reuse a saved form. <br /> File Original with DWR p* State of California DWR Use On -Do Not Fm In <br /> Well Completion Report ii1i I Ill IF—] <br /> Page Of Refer to Inebucl/on Pamphlet State Well Number/Site Number <br /> Owners Well Number M-56A No. e0168534 <br /> Date Work Began 01/09/2013 Date Work Ended 1/11/2013 Latitude Lon elude <br /> Local Permit Agency San Joaauin County Environmental Health <br /> Permit Number 0066245 Permit Date 12/6/12 APNrrRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name City of Ripon <br /> Drilling Method Auger Drilling Fluid <br /> Depth from Surface Description - Mailing Address 259 N Wilma Ave. <br /> Feet to Feet Describe material rain size color,etc City Ripon State—C—A--Zip 95366 <br /> 0 40 Clay,stiff,semi-silty Well Location <br /> 40 80 Silty clay mix Address City of Ripon ROW Frontage Rd south of Hwy 99 <br /> 80 100 Sandy Silts mix,coarse mix City Ripon —County San Joaquin <br /> 100 120 Sandy silty mix,fine Latitude N Longitude_ w <br /> Deq. Min. Sec. Dec. Min. sec. <br /> Daturri Decimal Lat. Decimal Long. <br /> APN Book Page Parcel <br /> Township Range Section <br /> Location Sketch Activit <br /> Sketch must be draw by hand after form is printed. —(g New Well <br /> North 0 Modification/Repair <br /> 0 Deepen <br /> 0 Other <br /> — <br /> 0 Destroy <br /> undm'G nm..a.nm.nd mm.a.i. <br /> nne.,�ceococic Loc <br /> Planned Uses <br /> 0 Water Supply <br /> ❑Domestic [I Public <br /> 3 w ❑Irrigation ❑Industrial <br /> 0 Cathodic Protection <br /> 0 Dewatering <br /> 0 Heat Exchange <br /> 0 Injection <br /> 0 Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> South 0 Test Well <br /> nwv.t.wa«aeaew.nca a.an rm,n m.aa,e.iuhy.,f.n.�. 0 Vapor Extraction <br /> P' ,wcanamama m.p.U..Mdaanm w.e<en.=ma.ry 0Other <br /> W.amW.ccu,mandcom Iete <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 115 Feet Estimated Yield` (GPM) Test Type <br /> Total Depth of Completed Well 115 Feet Test Length (Hours) Total Drawdown (Feet) <br /> *May not be representative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Type If Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 105 8 Blank pvC Sch 40 12 1 0 101 Cement Portland <br /> 105 115 8 Screen' PVC Soh 40 2 slot 0.020 101 103 Bentonite Chips <br /> 103 115 Sand #3 <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, L.P. <br /> Person,Firm or Corporation <br /> ❑ Geophysical Log(s) 3632 Omec Circle- Rancho Cordova CA 95742 <br /> ❑Other ter Chemical Analyses r city state zip <br /> ❑+ Other Site Map <br /> Signed b 01/24/13 938110 <br /> Attach additional information bit exists. G57 Licensed ale eu ontraaor Date Signed C-57 License Number <br /> DWR 188 REV.1=06 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />