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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 /> Well Completion Report <br /> Page of Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number NO. e0355639 I I-iN1 F 1 17 1 1 1 1vv1 <br /> Date Work Began 09/12/2017 Date Work Ended 9/21/2017 Latitude Longitude <br /> Local Permit Agency San.Inane tin Health Dept <br /> Permit Number 37172 Permit Date APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name Marlene CDonce <br /> Drilling Method mud rota Drilling Fluid Bentonite mud Mailing Address P.O.Box 660 <br /> Depth from Surface Description Ripon CA 95366 <br /> Feet to Feet Describe material, rain size,color,etc Ci State I <br /> 0 4 sand Well Location <br /> 4 6 hardpan Address 15127 French Camp Rd. <br /> 6 16 sand City Ripon County San Joaquin <br /> 16 28 clay Latitude N Longitude _Jnl <br /> 28 70 sand Dea Min Sec. Deo Min Sec <br /> 70 130 clay Datum Dec.Lat. Dec.Long. <br /> 130 147 Sand APN Book 203 Page 110 Parcel 10 <br /> 147 157 clay Township Ran a Section <br /> 157 190 sand Location Sketch Activity <br /> 190 194 clay Sketch must be drawn by hand <br /> after form is Printed.) O New Well <br /> North <br /> 194 201 sand O Modification/Repair <br /> O Deepen <br /> 201 210 clay O Other <br /> 210 221 Sand O Destroy <br /> oesc;ea poeedsrea and materinla <br /> 221 235 fine sand with clay streaks Inde ceaoalcLoc- <br /> 235 240 sand <br /> Planned Uses <br /> 240 256 clay Water Supply <br /> 256 259 sand E]Domestic ❑Public <br /> � w ❑Irrigation ❑Industrial <br /> 259 274 clay <br /> O Cathodic Protection <br /> 274 280 sand w/clay streaks <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> Inuaante«d—tbedW--ofWell t—r—m,:Adna.1-' OVapor Extraction <br /> fNers,etc.end attach a map.Ute additional paper it necessary. O Other <br /> IPI-b-una wdcompMa. <br /> ater Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level 62 (Feet) Date Measured <br /> Total Depth of Boring 280 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 240 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 /> 0 200 14 Blank PVC .322 8 0 108 quik grout <br /> 200 240 14 screen PVC .322 8 0.050 108 240 No 6 sand pack <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 Hennings Bros. Drilling Co.,inc. <br /> El Geophysical Lo Person,Firm or Corporation <br /> 9(S) 1930 Ladd Rd. Modesto CA 95356 <br /> ❑ Soil/Water Chemical Analyses I Add ss city state zip <br /> 13Other Signed 10/23/2017 290813 <br /> Attach additional information if it exists C-57 qcensed Water Well C#tractor Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPA E IS NEEDED.USE NEXT CONSECUlfkELY NUMBERED FORM <br />