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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 On -Do Not Fill In <br /> Page 1 of 1 Well Completion Report <br /> s Well Number AMW-29S Rotor to Instruction Pamphlet State Well Number/Site Number <br /> N <br /> Owner No. e0106873 w <br /> Date Work Began 02/03/2010 Date Work Ended 2/4/2010 Latitude Lon itude <br /> ' Local Permit Agency San Joaauin County <br /> Permit Number SR 0059144 Permit Date 1/12/10 1 APNlrRS/Other <br /> Geologic Log Well Owner <br /> ' Orientation OVertical 0Horizontal OAngle Specify Name Forward Incorporated <br /> Drilling Method Mud Rotary Drilling Fluid Bentonite Mud Mailing Address 9999 South Austin Road <br /> Depth from Surface Description <br /> Feet to Feet Describe material rain size color,etc City Manteca State CA 7Ip 95336 <br /> 0.0 122.0 Blind drill to 122.0 feet below ground surface. Well Location <br /> ' Address 27011 South Austin Road <br /> City Ripon County San Joaquin <br /> Latitude 37 53 29.02 N Longitude -121 10 44.88 W <br /> ' Deo. Min. Sea Deo. Min. See, <br /> Datum WGS 84 Decimal Lat. 37.8914 Decimal Long.-121.1791 <br /> APN Book 181 Page 16 Parcel 7 <br /> 'Township AN-Range 7E Section 35 <br /> ' Location Sketch Activity <br /> sketch must be drawn by hand after form is 'nted. Oi New Well <br /> North <br /> O Modification/Repair <br /> O Deepen <br /> ' See attached O other <br /> FO Destroy <br /> Figure 1 <br /> Describe procedures ane matenals <br /> u.dor'GEOLOGIC LOG <br /> Well Location Map Planned Uses <br /> ' O Water Supply <br /> ❑Domestic []Public <br /> to ❑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 /> loustrete or' desodbe datenee of M1 from roads,buildup,farhpa, O Vapor Extraction rivara,arc.and eltadh a map.Uw additional paper a neorary. O Other <br /> PWaaG see <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> ' Depth to Static <br /> Water Level 69.89 (Feet) Date Measured 06/14/2010 <br /> Total Depth of Boring 122 Feet Estimated Yield` (GPM) Test Type <br /> Test Length (Hours)Total Drawdown (Feet) <br /> Total Depth of Completed Well 122 Feet May not be representative of a well's long term yield. <br /> ' Casings Annular Material <br /> Depth from Borehole Type Materiel 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 Feel <br /> 0 1102 18 Blank PVC Sch.80 0.375 2.75 1 0.0 95.4 1 Cement Portland <br /> 102 122 8 Screen' PVC Sch.80 0.375 2.75 1 Milled Slots 0.010 95.4 98.6 Bentonite 7Pellets <br /> 98.6 122.0 Filter Pack #2/12 <br /> Attachments Certification Statement <br /> ' ❑Geologic Log I,the underslolikid.redi'f9 at is report iseland crate o the best of my knowledge and belief <br /> D Well Construction Diagram Name f <br /> ❑Geophysical Log(s) 01el M <br /> Firm n <br /> 0 Soil/Water Chemical Analyses C4 state <br /> ' 1:3 other Signed b L 3110 Attach additional mformahon d it emsts. C-57 Licensed Water Well Contractor Date Slatted C-57 License Number <br /> DWR 188 REV.112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />