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'The free Adobe Reader may be used to view and complete th 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 State Well Number/Site Number <br /> Owner's Well Number MW-39 No, e0268979 I I 17TN] 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 Mailing Address 2235 Mercury Way Suite 150 <br /> * ehJrR " CSant2 Rosa State Ch95407 <br /> Fe tie material <br /> ee, oe <br /> 0 20 Sandy silty mix,fine grains Well Location <br /> 20 40 Well graded sand,fine to coarse sand, Address 2072 W Yosemite Ave <br /> some fine sub-rounded pea gravel City Manteca County San Joaquin <br /> 40 60 Sandy silty clay mix,fine grains,brownish yellow Latitude N Longitude W <br /> 60 76 Sandy silty mix,fine sands,silty,fine to coarse Deo. Min. Sec. Dea. Min. Sec. <br /> sand 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 /> O Destroy <br /> Describe procedures and materials <br /> uMer'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> dt w ❑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 /> Illustrateordesedbe distance of well from roads.buildings,fences, O Vapor Extraction <br /> rivers,etc.and attach a map.Use additional paper if necessaryOther <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 76 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 76 Feet <br /> 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 Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Type If Any Surface Fill Description <br /> Feet to Feet Inches Inches (inches)__ Inches Feet to Feet <br /> 0 66 8Blank PVC SCh 40 2 0 62 Cement Portland <br /> 66 76 8 screen PVC SCh 40 2 Slot 0.020 62 64 Bentonite Chips <br /> 64 76 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 /> — <br /> Person,Firm or Corporation <br /> ❑ Geophysical Log(s) 3000 Dulufh StretA West Sacramento CA 95691 <br /> ❑ Soil/Water Chemical Analyses A r s City State zip <br /> D Other Site Mar) Signed ✓ 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.112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />