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t <br /> � r <br /> 'The free Adobe Reader may be used to view and camhis form. However,software must be purchased to complete and reuse a saved form. <br /> File Original with DWR State of California DWR Use Onl –Do Not Fill In <br /> Page of Well Completion Report <br /> Re/erro Instruction Pamphlet <br /> Owner's Well Number M-57A No. e0168535 State Well Number/SRe Number <br /> Date Work Began 01/09/2013 1—I <br /> 9 Date Work Ended l/11/2013 Latitude IN Lon nude <br /> Local Permit Agency San Joaauin County Environmental Health <br /> Permit Number 0066245 Permit Date 12/6/12 A'N/TRs/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 Mailing Address 259 N Wilma Ave. <br /> P Description <br /> Feet to Feet Describe material grain size,color,etc City Ripon Stale Chi 95366 <br /> 10 140 Clay,stiff,semi-sit Well Location <br /> 40 180 Silty clay mix Address City of Ripon ROW Frontaoe Rd south of Hwv 99 <br /> 80 1100 Sandy silts mix,coarse mix city RiponCounty San Joaquin <br /> 100 120 Sandy sit mix,fine Latitude N Longitude _w <br /> Deo. Min. Sec. Dec. Min. Sec. <br /> Datum Decimal Lat. Decimal Long. <br /> APN Book Page Parcel <br /> Township —Range Section <br /> Location Sketch Activit <br /> (Sketch must be drawn by hand after form is printe, Q New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> — <br /> 0 Destroy <br /> oamlie paa and mai,,;al. <br /> uMc'GEOLOGIOLOGIc LOG' <br /> Planned Uses <br /> 0 Water Supply <br /> E]Domestic []Public <br /> w ❑Irrigation ❑Industrial <br /> 0 Cathodic Protection <br /> 0 Dewatering <br /> 0 Heat Exchange <br /> 0 Injection <br /> (D Monitoring <br /> 0 Remediation <br /> 0 Spangling <br /> South 0 Test Well <br /> Inusmale or dox,mba distance or wall fmm mads.bmlairgafacr-. O Vapor Extraction <br /> dws.sec,and adam a map,use adedJa asx Ir nee.ssan. O Other <br /> YMeaa ba ecmrate entic bla. <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 re resentative 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 FeetInches Inches Inches Inches Feet to Feet <br /> 0 105 81 Blank 1PVC I Sch 40 2 1 0 101 Cement Portland <br /> 105 115 18 1 Screen IPVC SCh 40 2 Slot 0.020 101 103 Bentonite Chips <br /> 103 115 Sand #3 <br /> Attachments - Certification Statement - <br /> ❑ Geologic Log I,the undersigned,Ca ty that this report is complete and accurate to the best of my knowledge and belief <br /> 11 Well Construction Diagram Name Cascade Drillina L.P. <br /> ❑ Geophysical Log(s) Person,Firm or Corporation <br /> 3632 Ome Circle Rancho Cordova CA 95742 <br /> ❑ Soil/Water Chemical Analyses Ams city stat. rip <br /> ❑� Other Site Mao Signed �( ny�n ,.� 01/24/13 938110 <br /> Attach additional information Hit exists. C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> DWR 188 REV.112006 IF ADDITIONAL SPACE IS NEEDED.USE NEXT CONSECUTIVELY NUMBERED FORM <br />