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'The free Adobe Reader may be used to view and complete tt. 1. 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 Instruction Pamphlet <br /> State Well Number/Site Number <br /> Owner's Well Number MW-38 No. e0268977 I I I I N w <br /> Date Work Began 03/02/2015 Date Work Ended 3/13/2015 Latitude Longitude <br /> Local Permit Agency San Joaauin 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 Specify Name GHD, Inc. <br /> Drilling Method Auger Drilling Fluid <br /> Feet tQoFeet � 'Desc�itie ° • �� Mailing Address 2235 Mercury Way Suite 150 <br /> mat"nal, rain size,color,etc Ci� a—ROSa State dip 7� <br /> 0 20 Sandy silty mix,strong brown Well Location <br /> 20 40 Well graded sand,fine to coarse sand, Address 2072 W Yosemite Ave <br /> sub-rounded/pea gravel mix City Manteca County San Joaquin <br /> 40 60 Lean clay,yellowish-brown, mottled reddish brown Latitude N Longitude W <br /> 60 80 Silty sandy mix,fine grain,coarse to fine mix Dec. Min. Sec. Dea. Min. Sec. <br /> 80 100 Silty sandy mix,fine sands, silty mix 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.) O New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> 0 Destroy <br /> Describe procedures and materials <br /> under'GEOLOGIC LOG' <br /> 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 /> Sparging <br /> SouthO Test Well <br /> Illustrate or describe distance of well from roads,buildings,fences, O Vapor Extraction <br /> fivers,etc.and attach a map.Use additional paper H 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 100 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 100 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 yp Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 90 18 Blank 1PVC SCh 40 2 0 186 Cement Portland <br /> 90 100 18 Screen PVC SCh 40 2 Slot 0.020 86 88 Bentonite Chips <br /> 88 100 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 Analyses — <br /> City State zip <br /> ❑� Other Site Mar) SigneLI <br /> r Q�, ` 05/29/15 938110 <br /> Attach additional information,if it exists. C-57 Licensed Water ell Contractor Date Signed C-57 License Number <br /> DWR 188 REV.12006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />