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City Tracy County San Joaquin Datum CL - clay, L. brown APN Book 255 Page 100 Parcel 04 ® New Well o Modification/Repair 0 Deepen 0 Other 0 Destroy Describe procedures and materials under 'GEOLOGIC LOG' Activity Location Sketch (Sketch must be drawn by hand after form is printed ) North Lu 0 Water Supply ['Domestic ID Public El Irrigation 0 Industrial 0 Cathodic Protection 0 Dewatering 0 Heat Exchange 0 Injection 0 Monitoring 0 Remediation Sparging 0 Test Well 0 Vapor Extraction 0 Other (Feet) Estimated Yield (GPM) Test Type Test Length (Hours) Total Drawdown May not be representative of a well's long term yield Type Material Fill Description Depth from Surface Feet to Feet Depth from Borehole Surface Diameter Feet o Feet (Inches) Wall Outside Screen Slot Size Thickness Diameter Type if Any (Inches) (Inches) (Inches) 8 8 20 25 1 Blank 15 18 25 PVC Sch. 40 PVC Sch. 40 Cement 20 Screen 0.020 15 18 Sand Milled Slots Bentonite Filter Pack Corpor rive Person, Firm o 3806 Duc Creek Contract r C-57 Licensed ter VV DWR Use Only — Do Not Fill In i . I I I I I I I State Well Number/Site Number I I I I I N i I I I I 1 1 'Ail Latitude Longitude I I I I i I I I I I I 1 I I APNTTRS/Other Well Owner Refer to Instruction Pamphlet No. e0228848 Date Work Ended 6/25/2012 Local Permit Agency San Joaquin County Environmental Health Department Owner's Well Number AS-3 Page 1 of 1 Date Work Began 06/25/2012 'The free Adobe Reader may be used to view and compir File Original with DWR is form. However, software must be purchased to complete, e ,nd reuse a saved form. State of California Well Completion Report Orientation 0 Vertical 0 Horizontal 0Angle Specify Drilling Method Hollow Stem Auger Drilling Fluid Feet to Feet 5 7 10 12 15 17 20 22 25 26 26 27 Name Teranishi Irrevocable Trust Mailing Address 1600 Durham Ferry Road City Tracy State CA 7ip 95304 Well Location Address 1600 Durham Fern/ Road Latitude 37 40 2 N Longitude 121 19 37 w Deo Min. Sec. Deo Min. Sec. Dec. Lat. Dec. Long. Depth from Surface Description Township Range Section Planned Uses Water Level and Yield of Completed Well Total Depth of Boring 27 Total Dep h of Completed Well 25 Casings Annular Material Feet Feet Attachments CI Geologic Log CI Well Construction Diagram 0 Geophysical Log(s) 0 Soil/Water Chemical Analyses 0 Other Location Map Attach additional information, if it exists. DWR 188 REV. 1/2006 Certification Statement I, the undersigned, certify that this report is omplete and accurate to the best of my knowledge and belief Name Karli Stroing, Drilling, In City 4,11,...\ State Date Si ned C-57 License Number 720904 Zip on i tockton Signed CA 95215 IF ADDITIONAL SPACE IS htEDED, US NEXT CONSE TIVELY NUMBERED FORM Permit Number SR0065190 Permit Date 6/19/12 Geologic Log Describe material, grain size, color, etc ML - sandy silt, brown CL - sandy clay, brown w/ black spots ML - sandy silt, grayish brown SM - silty sand, grayish brown SW - sand, brown South Illustrate or describe distance dwell from roads, buildings, fences rivers, etc. and attach a map. Use additional paper if necessary Please be accurate and complete Depth to Static Water Level 12 (Feet) Date Measured Depth to first water 10 (Feet below surface)