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<br /> ' File Original with DWR State of California DWR Use Only-Do Not Fill in
<br /> Pa4 of 5 Well Completion Report
<br /> Page Refer to lnshuction Pamphlet State Well Number/Sits Number
<br /> Owner's Well Number AMW-29 No. e0106872 FN w
<br /> ' Date Work Began 01/27/2010 Date Work Ended 02/02/2010 Latitude Lon itude
<br /> Local Permit Agency San Joaquin County
<br /> Permit Number SR 0059146 Permit Dale 1/12/10 APNrrRS/Other
<br /> Geolo is Log Well Owner
<br /> Orientation O Vertical O Horizontal OAngle Specify Name Forward Incorporated
<br /> Drilling Method Mud Rota Drilling Fluid Bentonite mud Mailing Address 9999 South Austin Road
<br /> Depth from Surface Description Manteca
<br /> Feet to Feet Describe material rain size color,etc Cit State CA -zip 95336
<br /> ' 110.2 110.4 CLAY&GRAVEL,wet. Cl a is soft highly iastic, Well Location
<br /> dark gray(10YR 4/1). Gravel is fine grained and Address 27011 South Austin Road
<br /> subangular. City Ripon County San Joaquin
<br /> 110.4 111.3 SAND with gravel at base,wet,well sorted, Latitude 37 53 29.12 N Longitude -121 10 44.69 w
<br /> medium grained,dark yellowish brown(10YR 4/6). Deo. Min. See. Dec. Min. See.
<br /> 111.3 111.5 GRAVEL,wet,subangular,dark yellowish brown Datum WOS 84 Decimal Lat. 37.8914 Decimal Long.-121.1791
<br /> (10YR 3/4). Contains coarse,subrounded sand. APN Book 181 Page 16 Parcel 7
<br /> 111.5 115.2 GRAVEL. Township 1 N Ran a-7E Section 35
<br /> ' 115.2 116.0 GRAVEL,wet,subangular,dark yellowish brown Location Sketch Activity
<br /> 10YR 3/4). Contains coarse,subrounded sand. faimM rmim be drawn by nand after form is nted. New Well
<br /> 116.0 116.5 SAND,wet,medium to coarse grained,well sorted, Nom O Modification/Repair
<br /> O Deepen
<br /> subrounded,micaceous,grayish brown See attachedO Other
<br /> 2.5Y 5/2). O Destroy
<br /> Fiu re 1 Describe ProcWW"ane marenels
<br /> 116.5 120.0 SAND. g wWw'oeoLootcl.oc•
<br /> 120.0 121.0 GRAVEL,wet,subangular,dark yellowish brown Well Location Map Planned Uses
<br /> ' 10YR 3/4). Contains coarse,subrounded sand. O Water supply
<br /> 121.0 121.5 SAND,wet,medium to coarse grained,well ❑Domestic ❑Public
<br /> sorted,subrounded,micaceous,grayish brown w ❑Irrigation ❑Industrial
<br /> 3
<br /> ' (2 5Y 5/2) O Cathodic Protection
<br /> O Dewatering
<br /> 121.5 126.0 SAND. O Heat Exchange
<br /> 126.0 126.5 SAND,wet,medium to coarse grained,well sorted, O Injection
<br /> ' subrounded,micaceous,grayish brown G Monitoring
<br /> (2.5Y 5/2). O Remediation
<br /> 126.5 131.0 SAND. O Sparging
<br /> 131.0 131.5 SAND,wet,medium to coarse grained,well sorted, south O Test Well
<br /> subrounded,micaceous,grayish brown eWstraMadesenbeW Wr,cod�veceemrads,buklaW,re,�es, O Vapor Extraction
<br /> 9 dwrs.em ea rep.We ed0lomi p Wr n neeeemy O Other
<br /> eue
<br /> (2.5Y 5/2). Plbe eeeuab end
<br /> 131.5 135.7 SAND. Water Level and Yield of Completed Well
<br /> Depth to First water (Feet below surface)
<br /> ' Depth to Static
<br /> Water Level 70.13 (Feet) Date Measured 06/14/2010
<br /> Total Depth of Boring 171.5 Feet Estimated Yield' (GPM) Test Type
<br /> Total Depth of Completed Well 170 Feet Test Length (Hours)Total Drawdown (Feet)
<br /> ' I*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 Io Feet Inches Inches Inches Inches Feet to Feet
<br /> 0 150 8 Blank PVC son.80 0.375 2.75 0.0 144.0 Icament Portland
<br /> 150 170 8 Screen PVC Sch.80 0.375 2.75 Milled Slots 0.010 144.0 146.6 Bentonite Pellets
<br /> 146.6 170.0 Fitter Pack #2/12 Sand
<br /> Attachments Cerdflcation Statement
<br /> ' ❑Geologic Log 1,the unde ftt this repo is m I Ca rate to the best of my knowledge and belief
<br /> 0 Well Construction Diagram Name
<br /> ❑Geophysical Log(s) CA 45:16.,105
<br /> O Soil/Water Chemical Analyses titres c state
<br /> 1:1 Other Signed /0
<br /> ' I Attach additional information,d it awsts. Date Signed C-57 License Number
<br /> DWR ISS REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM
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