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Depth to first water 10 <br />Depth to Static <br />Water Level 12 <br />Estimated Yield * <br />Test Length <br />*May not be representative of a well's long term yield. <br />(Feet below surface) <br />(Feet) Date Measured 06/25/2012 <br />(GPM) Test Type <br />(Hours) Total Drawdown (Feet) <br />Refer to Instruction Pamphlet <br />No. e0228846 <br />Date Work Began 06/25/2012 Date Work Ended 6/25/2012 <br />Local Permit Agency San Joaquin County Environmental Health Department <br />Owner's Well Number AS-1 <br />Page 1 of 1 <br />'The free Adobe Reader may be used to view and comp! <br />File Original with DWR <br />',is form. However, software must be purchased to complete, r <br />State of California <br />Well Completion Report <br />ind reuse a saved form <br />DWR Use Only — Do Not Fill In <br />1 I 1 1 1 1 1 I <br />State Well Number/Site Number <br />1 I I N I 1 I I I <br />r <br />W Latitude Longitude <br />I I I I 1111111 <br />APNITTIRS/Other Permit Number SR0065190 Permit Date 6/19/12 <br />Geologic Log <br />Orientation ()Vertical 0 Horizontal °Angle Specify <br />Drilling Method Hollow Stem Auger Drilling Fluid <br />Depth from Surface Description <br />Feet to Feet Describe material, grain size, color, etc <br />0 14 GW - excavation fill <br />15 17 CL - sandy clay, dark grayish brown <br />20 22 CL - silty clay, grayish brown <br />25 26 SC - clayey sand, dark brown <br />26 27 CL - sandy clay, dark grayish brown <br />Total Depth of Boring <br />Total Depth of Completed <br />26 Feet <br />Well 24 Feet <br />Casings <br />Depth from Borehole Wall Outside Type Material Surface Diameter • Thickness Diameter <br />Feet o Feet (Inches) (Inches) (Inches) <br />22 8 Blank PVC Sch. 40 1 <br />22 24 8 Screen PVC Sch. 40 <br />Well Owner <br />Name Teranishi Irrevocable Trust <br />Mailing Address 1600 Durham Ferry Road <br />City Tracy State CA 7ip 95304 <br />Well Location <br />Address 1600 Durham Ferry Road <br />City Tracy County San Joaquin <br />Latitude 37 40 2 N Longitude 121 19 37 VI/ <br /> <br />Dee. Min. Sec <br />Dec. Long. <br />Parcel 04 <br />Township Range Section <br />Activity <br />North <br />Planned Uses <br />South <br />Illustrate or describe distance of well from roads, buildings, fences <br />rivers, etc. and attach a map. Use additional paper if necessary <br />Please be accurate and complete <br />Water Level and Yield of Completed Well <br />Annular Material <br />Depth from <br />Surface Fill Description <br />Feet o Feet <br />Cement <br />Milled Slots <br />Datum <br />APN Book 255 <br />Dea Min. Sec. <br />Dec. Lat. <br /> Page 100 <br />Location Sketch <br />(Sketch must be drawn by hand after form is printed.) <br />0 Water Supply <br />El Domestic DPublic <br />El Irrigation 0 Industrial <br />0 Cathodic Protection <br />0 Dewatering <br />0 Heat Exchange <br />Injection <br />Monitoring <br />Remediation <br />0 Sparging <br />0 Test Well <br />0 Vapor Extraction <br />0 Other <br />0 New Well <br />0 Modification/Repair <br />0 Deepen <br />0 Other <br />0 Destroy <br />Describe procedures and materials <br />under 'GEOLOGIC LOG' <br />Screen <br />Type <br />Slot Size <br />if Any <br />(Inches) <br />16 <br />0.020 16 19 Bentonite <br />Filter Pack 19 Sand 26 <br />Attachments <br />0 Geologic Log <br />0 Well Construction Diagram <br />0 Geophysical Log(s) <br />0 Soil/Water Chemical Analyses <br />0 Other Location Map <br />Attach additional information, if it exists. <br />DWR 188 REV 1/2006 <br />Certification Statement <br />I, the undersigned, ce that this rep is complete and accurate to the best of my knowledge and belief Name Karli Stroin V& Drilling, In <br />Person, Finn •r Cor'por'ation <br />3806 Du 'k Creek ive <br />Signed <br />IF ADDITIONAL SPACE IS N EDED E NEXT COSo UTIVELY NUMBERED FORM <br />Stockton <br />-0/1MAth t <br />aty <br />C-57 Licensed ater Contract <br />720904 17 <br />Date S4ned C-57 License Number <br />CA 95215 <br />State Zip