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"ibi free Adobe Reader may be used to view and corn is form. `However, software must`be purdhased'to complet and reuse a saved gorm. File Original with DWR Page 1 of 1 Owner's Well Number MW3A Date Work Began 05/28/2013 Local Perrtiit Agency San Joaouin Permit Number 07120 State of California Well Completion Report Refer to Instruction Pamphlet No. e0185526 Date Work Ended _5/29!2013 EHD Permit Date 5/8/13 DWR Use Only — Do Not Fill in Name San Joaouin Public Works- Solid Waste Dovosion Mailing Address 1810 East Hazleton Ave City Stockton State —CA--zig 95207 Well Lavation Depth from Surface Description Feet to Feet Describe material rain size color, etc W tate ell Number/Site Number N Q1 I I 1 W Latitude Longitude 8 13 Yellow Brown Sand APN/TRS10ther Geologic Log Well Owner Orientation OVertical O Horizontal OAngie Specify Drilling Method Direct Rotary Drilling Fluid Bentonite mud Name San Joaouin Public Works- Solid Waste Dovosion Mailing Address 1810 East Hazleton Ave City Stockton State —CA--zig 95207 Well Lavation Depth from Surface Description Feet to Feet Describe material rain size color, etc 0 8 Gray Brown Sandy Silt 8 13 Yellow Brown Sand Address 14750 East Harney Lane City Lodi County San Joaquin Latitude N Longitude __nr Den. Min. sec. Dec. Min. Sec. Datum Dec. Lat. Dec. Long. APN Book 065 Page _030 Parcel 06 Township Range Section 13 17 Brown Clay with Sand 17 30 Olive Brown Sandy Clay 30 32 Yellow Brown Sandy Silt 32 42 Yellow Brown Sand 42 50 Yellow Brown Sandy Silt 50 70 Yellwo Brown Sand with Silt 70 75 Olive Brown Silt with Sand Location Sketch Sketch moat be drawn ?Nhafnd atterromt is tinted. Activity 75 80 Brown Claystone G) New Well Modification/Repair O Deepen O Other O Destroy Describe procedures and materials under`G�OLOGIC LOG ortO 80 85 Brown Silt fa, __.___ = --- -- �— `" ` +�t { y ` H 2 LU Q ifp e 3 A South 85 110 Brown Silt to Clayey Silt 110 120 Yellow Brown Silty Sand 120 138 Yellow Brown Silt and Clayey Silt 138 148 Dark Gray Brown Gravel with Sand Planned Uses 148 155 Brown Silt with Sand to Clayey silt Dourest cpl❑Public O[:]Domestic ❑ Irrigation []Industrial O Cathodic Protection O Dewatering O Heat Exchange O Injection 0 Monitoring O Remediation O Sparging O Test Well O Vapor Extraction O Other 155 162 Yellow Brown Clay with Silt Illustrate ar describe distance ofwen from roads, buds ings, fences, rivers, etc. and attach a map. Use additional paper If necessary. Pfease be accurate and com late. Water Level and Yield of Completed Well Depth to first water. (Feet below surface) Depth to Static Water Level (Feet) Date Measured Estimated Yield ` (GPM) Test Type Test Length (Hours) Total Drawdown (Feet) "Ma not be re resentative of a well's lonq term yield. Total Depth of Boring 161.5 Feet Total Depth of Completed Well 160 Feet Casings Annular Material Depth from Borehole wall Outside Screen Slot Size Surface Diameter Type Material Thickness Diameter Type if Any Feet to Feet Inches Inches Inches Inches Depth from Surface Fill Description Feet to Feet 0 140 110 Blank PVC Sch. 80 12.375 1 0 1130 1 Cement 140 160 10 Screen PVC Sch. 80 12.375 Milled Slots 0.020 130 1135 1 Bentonite Pellets 0 140 10 Blank PVC Sch. 80 1.25 135 162 1 Filter Pack 2/12 140 160 10 Screen PVC Sch. 80 1.25 Milled Slots 0.020 Attachments Certification Statement ❑ Geologic Log ❑ Well Construction Diagram ❑ Geophysical Log(s) ❑ Soil/Water Chemical AnalysesAdd 1:1 Other Attach additional information It it exists. I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief Name Gregg Drillino and Testing. Inc Person, Firm or Corporation 0 Howe Rd Martinez CA 94553 City _ / state zip Signed r ss ® 485165 C-57 icensed Water Well Contrac Date Signed C-57 License Number DWR 188 REV. 1/2008 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM