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`The free Adobe Reader may be used to view and complete th I. However,software must be purchased to complete,save, use a saved form. <br /> File Original with DWR State of California DWR Use Only—Do Not Fill In <br /> Well Completion Report - - <br /> Page Of Refer to Insiruclion Pamphlet <br /> Owner's Well Number MW-27 No. State Well Number/Site Number <br /> Owne <br /> e0268974 N w <br /> Date Work Began 03/02/2015 Date Work Ended 3/13/2015 Latitude Longitude <br /> Local Permit Agency San Joaquin County Environmental Health <br /> Permit Number 70157 Permit Date 7/25/14 APNrrRS/Other- <br /> Geologlic Log <br /> Well Owner <br /> Orientation O Vertical O Horizontal OAngle Speciry Name GHD, Inc. <br /> Drilling Method Auger Drilling Fluid Mailing Address 2235 Mercury Way Suite 150 <br /> .,... Cit an a o State�i ....... <br /> Feett t�teetti "Describe material; ran size,color,etc <br /> 0 15 Fine sands/silts mix,strong brown Well Location <br /> Address 2072 W Yosemite Ave <br /> City Manteca County San Joaquin <br /> Latitude N Longitude ____N <br /> Dea. Min. Sec. Dea. 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 isprinted.) New Wel I <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> O Destroy <br /> Descnhe procedures and malenals <br /> urder'GEOLOGIC LOG' <br /> Planned Uses <br /> 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 /> 0 Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> Illustrate ordescnbe distance or 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 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 15 Feet Estimated Yield* (GPM) Test Type <br /> Total Depth of Completed Well 15 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 g 18 Blank I PVC Sch 40 2 1 0 16 Cement Portland <br /> 8 15 8 Screen PVC Sch 40 2 Slot 0.020 6 7 Bentonite Chips <br /> 7 15 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 Drilling L.P. <br /> Person,Firm or Corporation <br /> ❑ Geophysical Log(s) 3000 Duluth Stret West Sacramento CA 95691 <br /> ❑ Soil/Water Chemical AnalysesPM <br /> City State zip <br /> ElOther Site Map Signed 1/ 05/29/15 938110 <br /> Attach additional information if it exists. C-57sed Water Well Contractor Date Signed C-57 License Number <br /> DWR 188 REV.112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />