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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 /> Page of Well Completion Report <br /> Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number MW-41 No. e0268981 <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 /> '-G66l6&'L6d 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 /> Depth from Surface Description Cit Santa Rosa State CA 7i 95407 <br /> Feet to Feet Describe material, rain size,color,etc P <br /> 0 20 Fine sands mix,silty mix,Strong brown Well Location <br /> 20 40 Well graded sand,fine to coarse sand,sub roundcl Address 2072 W Yosemite Ave <br /> pea gravel,greyish brown City Manteca County San Joaquin <br /> 40 77 Silty sandy mix,fine to coarse,dark greyish brown Latitude N Longitude w <br /> Dea. 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.) �j5 New Well <br /> North Q 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 /> Qw ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> G Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> Illustrate or describe dist nce of well from roads,buildings,fences. O Vapor Extraction <br /> rivers,etc.and allach a map Use additional paper ff 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 77 Feet Estimated Yield` (GPM) Test Type <br /> Total Depth of Completed Well 77 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 67 18 Blank Pvc Soh 40 12 1 0 163 Cement Portland <br /> 67 77 8 Screen PVC SCh 40 2 Slot 0.020 63 65 Bentonite Chips <br /> 65 77 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 /> ❑ Other a Site <br /> Chemical Analyses ' � Ad re city stale zip <br /> ❑ Other Site MaD 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.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NFXr CONSECUTIVELY NUMBERED FORM <br />