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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 2 of 2 Refer to Instruction Pamphlet <br /> Owner's Well Number AMW-22 No. e0084069 State Well Number/Site Number <br /> NI I I I I I I W <br /> 0 to Work Began 12/01/2008 Date Work Ended 12/3/2008 Latitude Longitude <br /> cal Permit Agency San Joaquin County <br /> Permit Number SR#0055550 Permit Date 10/22/08 APN/TRS/Other <br /> Ceoio iaL' << " 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 Description Mailing Address 9999 S.Austin Road <br /> Feet " to Feet Liescribe material,grain size,color,etc' City Manteca State CA __Zip 95336 <br /> 115.4 116.5 Clayey SILT,very stiff,slightly moist,organic Well Location <br /> lenses, rust staining, 10 YR 5/4 Address in SE quadrant of NCYCC 2100 of newcastle Rd <br /> 116.5 120.0 Clayey SILT City Stockton County San Joaquin <br /> 120.0 120.8 Clayey SILT,with organic lenses slightly higher in Latitude 37 53 30.14 N Longitude -121 11 41.4 <br /> numbers. Dec. Min. Sec. Dec. Min. Sec. <br /> 120.8 121.5 Clayey SILT,with organic lenses slightly higher in Datum WGS84 Decimal Lat. 37.892 Decimal Long.-121.195 <br /> numbers,except no organic lenses APN Book 181 Page 150 Parcel 02 <br /> 121.5 125.0 Sitly SAND Township 1 North Ran2e 7 East Section 34 <br /> 125.0 125.9 Sitly SAND,dry,fine grained, 10 YR 5/4 �" Location Sketch" Ac,,ti i <br /> Skeitohmiistbedrawin 4lhandafter form is printed.) O. New Well <br /> 125.9 130.0 Silty SAND <br /> O Modification/Repair <br /> 130.0 130.7 SAND,dry, loose fine grained,5 YR 4/4 <br /> O Deepen <br /> 130.7 135.0 SAND O Other <br /> 135.0 135.6 SAND O Destroy <br /> Describe procedures end materials <br /> 135.6 140.0 SAND under"GEOLOGICLOG" <br /> 140.0 140.5 SAND,with dark bands(5 YR 3/2) Planned Maps <br /> 140.5 140.8 CLAY,dry,very stiff, rust banding, 10 YR 5/4 O Water Supply <br /> [:]Domestic ❑Public <br /> w ❑Irrigation []Industrial <br /> O Cathodic Protection <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 /> Illustrate or describe distance of well from roads,buildings,fences, O vapor Extraction <br /> rivers,etc,and attach a map,Use additional paper if necessary. O Other <br /> Please be accurate and cam lets. <br /> Water Level and Yield of Completed Well <br /> Depth to first water N/A (Feet below surface) <br /> Depth to Static <br /> Water Level 66.03 (Feet) Date Measured 12/08/2008 <br /> Total Depth of Boring 140 Feet ***See Estimated Yield* N/A (GPM) Test Type N/A <br /> Total Depth of Completed Well 140 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' 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 /> 0 119 8 Blank PVC Sch.80 0.218 2.375 N/A N/A 0 111 Cement Quickrete Concrete <br /> 119 139 8 Screen' PV Sch.80 0.218 2.375 PVC 0.010 111 115 Bentonite Pel-Plug Bentonite Pellets <br /> 119 139 Sand 2/12 Cemex Lapis Lustre Sand <br /> Attachments Certification Statement, <br /> 70]Geologic 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&Assocites Inc <br /> Person,Firm or Corporation <br /> hysical Logs) 4630 S. Hwy 94-N.Outer Road Saint Charles MO 63304 <br /> ater Chemical Analyses Addre s City State zip <br /> Signed /—/S—U c1 636387 <br /> Anformation 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 <br />