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<br /> File Original with DWR State of California DWR Use Only-Do Not Fill In
<br /> Page 2 of 3
<br /> Well Completion Refer to Instruction pReport
<br /> Owner's Well Number AMW-23 No. e0084071 I
<br /> I I D I�hlet Sta-te_Well�NumSite Number
<br /> I I I "'I I I I I I I°°I
<br /> 0to Work Began 11/18/2008 Date Work Ended 11/20/2008 Latitude Longitude
<br /> cal Permit Agency San Joaauin County
<br /> Permit Number SR#0055551 Permit Date 10/22/08 APN/TRS/Other
<br /> Geol2gic Lqg Well Owner
<br /> Orientation E)Vertical 0Horizontal OAngle Specify Name Forward Incorporated
<br /> Drilling Method Mud Rotary Drilling Fluid Mud Mailing Address 9999 S.Austin Road
<br /> Depth froth Surface Descripti6n Manteca CA 95336
<br /> Feet to Feet Describe mater[at, rain size,color,etc Cit State_Zi
<br /> 110.2 111.5 Sandy CLAY,dry,very stiff, micas present Well Lavation
<br /> 10 YR 5/4 Address w/in 1500'West of Austin Road
<br /> 111.5 115.0 Sandy CLAY City Stockton County San Joaquin
<br /> 115.0 116.5 Sandy CLAY,with barite lenses Latitude 37 53 39.30 N Longitude;-121 11 21.58W
<br /> 116.5 120.0 Sandy CLAY,with barite lenses Dep. Min. Sec. Dea. Min Sec.
<br /> 120.0 120.3 Clayey SILT, moist stiff, 10 YR 5/4 Datum WGS84 Decimal Lat. 37.894 Decimal Long.-121.189
<br /> 120.3 121.5 Sandy CLAY,dry,very stiff, micus present, APN Book 181 Page 150 Parcel 11
<br /> 10 YR 5/4 Township 1 North Range 7 East Section 34
<br /> 121.5 125.0 Sandy CLAY t t cation Sketch ActiNd
<br /> 125.0 126.5 Sandy CLAY Sketchmustbedrawnb hand after form isPrinted.). (j) New Well
<br /> North O Modification/Repair
<br /> 126.5 130.0 Sandy CLAY O Deepen
<br /> 130.0 131.5 Silty CLAY,dry, med.stiff,rust staining,organic O Other
<br /> lenses, 10 YR 5/4 O Destroy
<br /> Describe procedures and materials
<br /> 131.5 135.0 Silty CLAY under ceoLocic Loc
<br /> 135.0 136.5 Silty CLAY Planned Uses
<br /> 136.5 140.0 Silty CLAY O Water Supply
<br /> 140.0 141.5 Clayey SILT,slightly moist, med.stiff, 5 YR 4/4 ❑Domestic ❑Public
<br /> El .5 145.0 Clayey SILT w ❑Irrigation ❑Industrial
<br /> .0 146.3 Sandy SILT,fine grained,pyrite flakes,dense O Cathodic Protection
<br /> O Dewatering
<br /> slightly moist, 5 YR 4/4 O Heat Exchange
<br /> 146.3 150.0 Sandy SILT O Injection
<br /> 150.0 155.0 Sandy SILT,fine grained sands O Monitoring
<br /> 155.0 155.7 Silty SAND,slightly moist,fine grained,some med- O Remediation
<br /> coarse gravels, marbled with oxidized'layers O Sparging
<br /> at bottom 5 YR 6/2 South O Test Well
<br /> Illustrate or describe distance of well from roads,buildings,fences, O Vapor Extraction
<br /> 155.7 155.8 SAND,fine grained,slightly moist,loose 5 YR 4/4 rivers,etc and attach a map use additional paper if necessary O Other
<br /> 155.8 160.0 SAND Please be accurate and complete,
<br /> 160.0 165.0 SAND,fine-coarse grained,sub-angular,`multi_ zrter Leve!and Yield of Completed Well,;
<br /> colored. Depth to first water N/A (Feet below surface)
<br /> Depth to Static
<br /> Water Level 69.77 (Feet) Date Measured 12/08/2008
<br /> Lotal, epth ofBoring 185 Feet ***See Estimated Yield* N/A (GPM) Test Type N/A
<br /> Note at Test Length N/A (Hours)Total Drawdown N/A (Feet)
<br /> epth of Completed Well 185 Feet Bottom *May not be representative of a well's long term yield.
<br /> Casin s AnnWar 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 /> 0 159 18 Blamk I PVC Sch.80 0.218 2.375 N/A N/A 0 150 Concrete Quickrete Concrete
<br /> 159 184 8 Screen PVC Sch.80 0.218 2.375 PVC 0.010 150 154 Bentonite Pel-Plug Bentonite Pellets
<br /> 159 184 Sane 2/12 Cemex Lapis Lustre Sand
<br /> Attachments Gertiflcation Statement
<br /> ❑r Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief
<br /> 0 WeII Construction Diagram Name Dave Vasbinder Herst&Associates Inc.
<br /> ❑Geophysical LO S Person,Firm or Corporation
<br /> Y g( ) 4630 S. Hwy 94-N.Outer Road Saint Charles MO 63304
<br /> M Soil/Water Chemical Analyses Ad ss City State zip
<br /> ❑ Other Signed _ 141 - o al 636387
<br /> Attach additional information if 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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