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'The free Adobe Reader may be used to view and complete thHowever,software must be purchased to complete,save, use a saved form. <br /> File Original With DWR State of Califomia DWR Use Only-Do Not Fill In <br /> Well Completion Report <br /> Page Of Refer to Instruction Pamphlet <br /> State Well Number/Site Number <br /> Owner's Well Number MW-36 No. e0268973 <br /> N W <br /> Date Work Began 03/02/2015 Date Work Ended 3/13/2015 Latitude Lon itude <br /> Local Permit Agency San Joaquin County Environmental Health I l t _I I I <br /> Permit Number 70157 Permit Date 7/25/14 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name GHD, Inc. <br /> Drilling Method Auger Drilling Fluid Mailing Address 2235 Mercury Way Suite 150 <br /> Depth from Surface Description Cit Santa Rosa State CA 7i 95407 <br /> Feet to Feet Describe material, rain size,color,etc P <br /> 0 20 Fine sands/silts mix,strong brown Well Location <br /> Address 2072 W Yosemite Ave <br /> City Manteca County San Joaquin <br /> Latitude N Longitude W <br /> Deo. Min. Sec. <br /> Deo. Min. Sec. <br /> Datum Dec.Lat. Dec.Long. <br /> APN Book Page Parcel <br /> -Township -Range Section <br /> Location Sketch Activit <br /> Sketch must be drawn by hand after form is printed.) (j) New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> Q Destroy <br /> Describe procedures and materials <br /> under"GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> [:]Domestic ❑Public <br /> 03 w ❑Irrigation ❑fndustrial <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 mads,buildings,fences, O vapor EXt(aCflOn <br /> rivers,etc,and attach a map.Use addilional paper If necessary. O Other <br /> Please be accurate and complete <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 20 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 17 Feet Test Length (Hours) Total Drawdown (Feet) <br /> May not be representative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole Type e 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 7 8 Blank IPVC Sch 40 2 0 5 Cement Portland <br /> 7 17 8 Screen PVC SCh 40 2 Slot 0.020 5 6 Bentonite Chips <br /> 6 17 Sand #3 <br /> Attachments Certification Statement <br /> ❑ Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑ Well Construction Diagram Name Cascade Driliing L.P. <br /> Person,Firm or Corporation <br /> ❑ Geophysical Log(s) 3000 Duluth Stret West Sacramento CA 95691 <br /> ❑ Soil/Water Chemical Analyses --nAddre In City state zip <br /> 0 Other Site Map Signed Ij �JS p,y- 05/29/15 938110 <br /> Attach additional information,'If it exists. C•57 Lcens d Water Well Contractor Date Signed C-57 License Number <br /> DWR 188 REV.12006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />