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<br /> File Original with DWR State of California DWR Use Only-`Do Not Fill In
<br /> Page 3 of 4 Well CompletionPh
<br /> Report
<br /> Refer to Instruction let State Well Number/Site Number
<br /> Owner's Well Number AMW-21 No. e0084068
<br /> to Work Began 11/04/2008 Date Work Ended_11/12/2008 Latitude N Longitude
<br /> cI Ral Permit Agency San Joaguin County
<br /> Permit Number Permit Date 10/22/08 APN/TRS/other
<br /> Geologic L9g, Well Owner
<br /> Orientation O Vertical O Horizontal OAngle Specify Name Forward Incorporated
<br /> Drilling Method Mud Rotary Drilling Fluid Mud
<br /> Depth from Surface Descrlption Mailing Address 9999 S.Austin Road
<br /> Feet to Feet Describe material,`rain size,color,'etc City Manteca State Chi 95336
<br /> 100.0 100.4 SAND,wet, med-coarse grained,some rounded Well Location
<br /> fine gravels,multi-colored Address 650'of Newcastle Rd along NCYCC S. Perimeter Road
<br /> 100.4 101.5 Silty SAND,wet,fine-med.grained, multi-colored City Stockton County
<br /> 101.5 105.0 Silty SAND Latitude 37 53 15.64 N Longitude -121 11 59.11w
<br /> 105.0 106.5 SAND,wet, poorly-sorted,med-coarse grained, Dea. rain sec. Dea. nein sec.
<br /> sub-angular Datum WGS84 Decimal Lat. 57.888 Decimal Long.-121.200
<br /> 106.5 110.0 SAND APN Book 181 Page 150 Parcel 08
<br /> 110.0 111.5 SAND,fine-med.grained, multi-colored,coarse ITownship 1 -North Range 7 East Section 34
<br /> grained sections,with sub-angular med.gravelslocation Sketch Acthift
<br /> 111.5 115.0 SAND Sketch must be drawn by';hand after form is printed..) (j) New Well
<br /> North O Modification/Repair
<br /> 115.0 115.7 SAND O Deepen
<br /> 115.7 116.4 Silty CLAY,dry,very stiff, rust banding, 10 YR 5/4 O Other
<br /> 116.4 116.5 Sandy SILT,damp,soft,fine sands,5 YR 4/4 0 Destroy
<br /> Describe procedures and materials
<br /> 116.5 120.0 Sandy SILT under'GEOLOGIC LOG"
<br /> 120.0 121.3 SAND, coarse sands grading down to med. sub- ;""Planned Usias
<br /> rounded gravels,wet, multi-colored. O Water Supply
<br /> 121.3 121.5 Clayey SILT,dry,hard, rust staining 10 YR 5/4 []Domestic El Public
<br /> ❑Irrigation ❑Industrial
<br /> 121.5 125.0 Clayey SILT w
<br /> O Cathodic Protection
<br /> 125.0 126.1 SILT, slightly moist, med.stiff,abundant micas
<br /> ® Dewatering
<br /> 10 YR 5/4
<br /> ® Heat Exchange
<br /> 126.1 130.0 No Recovery O Injection
<br /> 130.0 131.5 No Recovery O Monitoring
<br /> 131.5 135.0 Silty SAND O Remediation
<br /> 135.0 135.8 Silty SAND,wet, loose fine-med. grained, O Sparging
<br /> 10 YR 5/4 South O Test Well
<br /> Illustrate or describe distance of well from roads buildings,fences, O Vapor Extraction
<br /> 135.8 140.0 Silty SAND rivers,etc and attach a map. Use additional paper if necessary. O Other
<br /> 140.0 141.0 CLAY,very stiff,dry, rust staining, 10 YR 5/4 Please be accurate and complete.
<br /> 141.0 145.0 CLAY Ater Level and Yield of Completed Well
<br /> 145.0 146.3 CLAY Depth to first water N/A (Feet below surface)
<br /> Depth to Static
<br /> 146.3 1150.0 1 CLAY 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 /> Casings A_rirtular Material -�
<br /> Depth from Borehole Type Material Wall Outside Screen Slot Size Depth from
<br /> Surface Diameter 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 2/12 Cemex Lapis Lustre
<br /> Attachments Gertficatis>n Statement .
<br /> 7additional
<br /> gic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief
<br /> onstruction Diagram Name Dave Vasbinder Herst&Associates Inc.
<br /> Geophysical LO S Person,Firm or Corporation
<br /> g( ) 4630 S. Hwy 94-N. Outer Rd Saint Charles MO 63304
<br /> ater Chemical Analyses Address city scare zip
<br /> Signed -` _ (-(S-G9 636387
<br /> Attnformation if it exists. C-57 Licensed Water Well Contractor Date Signed 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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