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<br /> File Original with DWR State of California DWR Use Only-Do Not Fill In
<br /> Well Completion Report
<br /> Page 2 Of 4 Refer to Instruction Pamphlet
<br /> Owner's Well Number AMW-21 No. e00840$$ State Well Number/Site Number
<br /> N W
<br /> to Work Began 11/04/2008 Date Work Ended 11/12/2008 Latitude Longitude
<br /> cal Permit Agency San Joaouin County
<br /> Permit Number Permit Date 10/22/08 APN/TRS/Other
<br /> Geolo is o Well Owner
<br /> Orientation OVertical 0Horizontal OAngle Specify Name Forward Incorporated
<br /> Drilling Method Mud Rotary Drilling Fluid Mud Mailing Address 9999 S.Austin Road
<br /> Depth from Surface Description Manteca CA 95336
<br /> Feet to Feet Describe material,`rain size,color,etc Cit State_CA
<br /> 55.0 156.4 Clayey SILT Well Location
<br /> 56.4 60.0 Clayey SILT Address 650'of Newcastle Rd alona NCYCC S. Perimeter Road
<br /> 60.0 61.3 Silty CLAY, med.dry,very stiff,organic inclusions, City Stockton County
<br /> 10 YR 5/4 Latitude 37 53 15.64 N Longitude -121 11 59.11W
<br /> 61.3 65.0 Silty SAND Dec. Min. Sec. Deq. Min. Sec.
<br /> 65.0 66.2 Sitly SAND,slightly-moist,med.stiff,fine grained, Datum WGS84 Decimal Lat. 37.888 Decimal Long. -121.200
<br /> 5 YR 4/4,with dark organic lenses(10 YR 2/2) APN Book1181 Page 150 Parcel 08
<br /> 66.2 70.0 Silty SAND Township 1 North Range 7 East Section 34
<br /> 70.0 70.2 Silty SANDocaticrifSkech Activit
<br /> 70.2 70.5 Sitly CLAY, med.stiff,dry,5 YR 4/4
<br /> (Sketch mtistbodrawn b hand after form is anted. O' New Well
<br /> North O Modification/Repair
<br /> 70.5 71.5 Clayey SILT,dry,very stiff,abundant micas
<br /> O Deepen
<br /> present, barite lenses, 10 YR 4/4 O Other
<br /> 71.5 75.0 Clayey SILT O Destroy o�edu as and materials
<br /> 75.0 75.6 SAND,well-graded,wet, med-coarse grained undar GEOLOGIC oc
<br /> sands, some med.gravels, multi-colored. Planned Uses
<br /> 75.6 76.0 Silty SAND, med.grained,wet,5 YR 5/6 O Water Supply
<br /> 76.0 76.5 Silty SAND,fine grained,wet,5 YR 5/6 't;5 E] El Public
<br /> 3, w O Cathodic Protection
<br /> ❑Irrigation ❑Industrial
<br /> 76.5 80.0 Silty SAND
<br /> 80.0 80.5 Clayey SITL, soft, moist, micas present,5 YR 4/4
<br /> ® Dewatering
<br /> JlJ0.5 81.5 SILT,very stiff,dry, rust banding, micas present,, O Heat Exchange
<br /> 5 YR 4/4 O Injection
<br /> 81.5 85.0 SILT O Monitoring
<br /> 85.0 86.5 SILT,slightly moist O Remediation
<br /> 86.5 90.0 SILT,slightly moist O Sparging
<br /> 90.0 90.6 SILT,slightly moist South O Test Well
<br /> Illust=andattsch
<br /> tance of well from roads,buildings,fences, O Vapor Extraction
<br /> 90.6 90.7 SAND, med-coarse grained,wet, multicolored rivermap.Use additional paper if necessary. O Other
<br /> 90.7 95.0 SAND Plead complete.
<br /> 95.0 96.0 AND,grading down to fine grained ater Level and"Yeld of"Com leted Well
<br /> 96.0 100.0 SAND,grading down to fine grained Depth to first water N/A (Feet below surface)
<br /> Depth to Static
<br /> Water Level 62.43 (Feet) Date Measured 12/08/2008
<br /> Total Depth of Boring 176 Feet ***See Estimated Yield* N/A (GPM) Test Type N/A
<br /> Total Depth of Completed Well 143 Feet Note at Test Length N/A (Hours)Total Drawdown N/A (Feet)
<br /> Bottom *May not be representative of a well's long term yield.
<br /> Cash s; Art filar M61ierial
<br /> Depth from Borehole Type Material wall Outside Screen Slot Size Depth from
<br /> Surface Diameter YP Thickness Diameter Type if Any Surface Fill Description
<br /> Feet to Feet Inches Inches Inches Inches Feet to Feet
<br /> 0 122 8 Blank PVC Sch.80 0.218 2.375 N/A N/A 0 114 Cement Quickrete COncrete
<br /> 122 142 8 Screen PVC Sch.80 0.218 2.375 PVC 0.010 114 118 Bentonite Pel Plug Bentonite Pellets
<br /> 122 142 Sand 2112 Cemex Lapis Lustre Sand
<br /> 79additional
<br /> Attachments Certif-ication Statement,
<br /> gic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief
<br /> Construction Diagram Name Dave Vasbinder Herst&Associates Inc.
<br /> h SICaI LO S Person,Firm or Corporation
<br /> Y g( ) 4630 S. Hwy 94-N.Outer Rd Saint Charles MO 63304
<br /> ater Chemical Analyses Address City State zip
<br /> Signed 1Z / /-IS-oq 636387
<br /> Attnformation I it exists. C-57 Licensed Water Well Contractor Date Si ned C-57 License Number
<br /> ***Drilling depth scale begins at one foot above ground surface due to required drilling rig setup.
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