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`The free Adobe Reader may be used to view and complete It 1. However,software must be purchased to complete,save, fuse 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-40 No. e0268980 1N I I I I Iw <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 APNrFRS/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 /> . _ <br /> "Depth-from Sarface`�-'--- __ —,escr ptton'--"""-""' Santa Rosa CA 95407 <br /> Feet to Feet Describe material, rain size,color,etc Cit State_dip <br /> 0 14 Fine sands,silty mix,strong brown Well Location <br /> Address 2072 W Yosemite Ave <br /> City Manteca County San Joaquin <br /> Latitude N Longitude w <br /> Dec. 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 isprinted.) Q. New Well <br /> North 0 Modification/Repair <br /> O Deepen <br /> O Other <br /> O Destroy <br /> Describe procedures and materials <br /> under'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> Lu ❑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 /> SouthO Test Well <br /> Illustrateordescribe distance ofwell frarn roads,buildings,fences, O Vapor Extraction <br /> rivers,etc.and attach map. Use additional paper if necessary 0 Other <br /> Please be accurate ana d completa. <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 14 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 14 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 7 8 Blank PVC Sch 40 2 0 5 Cement Portland <br /> 7 14 8 Screen jPVC SCh 40 12 Slot 0.020 <br /> 56 Bentonite Chips <br /> E6 14 Sand #3 <br /> Attachments Certification Statement <br /> ❑ Geologic Log 1,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 Addy s n City state zip <br /> 0 Other Site Map Signed lit�/���- 05/29/15 938110 <br /> Attach additional information.if it exists. C-57 Ucense a[er Wet ntractor Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />