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'The free Adobe Reader may be used to view and complete it n. However,software must be purchased to complete,save, ruse 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 Instruction Pamphlet <br /> Owner's Well Number MW-37 No. e0268975 State well Number/Site I Number <br /> 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 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation OVertical 0Horizontal OAngle Speciry Name GHD, Inc. <br /> Drilling Method Auger Drilling Fluid <br /> De th from Surface Descri tion Mailing Address 2235 Mercury Way Suite 150 <br /> Feet to Feet ; + +1.w.m:. ascribe material, rain size,color,etc Cit Santa Rosa ----- State Chip-95407 <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 _ W <br /> Deo. Min. Sec. Dec. 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.) 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 /> w <br /> [:]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 /> O Vapor Extraction <br /> Illustrate or describe distance of well from roads.buildings,fences, <br /> rivers,etc.and attach a map.Use addilanal paper if necessary O Other <br /> Please be accurate and cornlata. <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 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 8 18 Blank JPVC SCh 40 2 1 0 16 1 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 /> Cl SoillWater Chemical Analyses city state zip <br /> 0 Other Site MaD Signed QhA V 05/29/15 938110 <br /> Attach additional information.if it exists. C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />