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'The free Adobe Reader maybe used to view and complete this form. However, software must be purchased to complete, save, and reuse a saved form. File Original with DWR State of California N /GREY Well Completion Report Page 1 of 1 Rotor to Instruction Pamphlet Owners Well Number #1 No. 90354939 Date Work Began 10110/2017 Dale Work Ended 1011312017 TM DEPT Local Permit Agency S ENVIRONMENTAL HFAI 9111117 DWR Use Ody —Do Not Fill In StaleWell Numbe�r/S,-- Number --�---�-� r� NJ I I I I I I LTJ Latitude Lan dude I t l1 11 1 1 1 AVN/rRWOther Permit Number 0037334 Permit Date Geolo Ic Lo Well Owner Orientation OVenicel 0Horizontal OAngle Specify _ Name JOHN OSPITAL D nln9 Method __ Dmhntt Fluid Mailing Address 8493 SUTHWORTH ROAD 0 1 1 25 N /GREY Address 27700 EAST Bf2ANDT ROAD 25 35 VEL City LODI County San Joaquin Latitude 38849 N Longitude 120 58 3�v 0.0 Min. Sec. 0— Min Sac260 Decimal Lat. Decimal Long.270 APN Book 067 Page 200 Parcel 01 Township T3N Range 129E --- Section 03 Location Sketch Activity Skeldt must Ce drawn o harts after loan is noted. Qa New Well North 0 Modification/Repair a at. wv 0 Deepen �� S / p RTy 0 Other O Destroy o••r^t•pr= •••• •m••^•'° ser'OEOLOGIe LOG' hf. • Planned Uses 1, O Water Supply ❑Domestic ❑Public w ❑Irrigation [Industrial O Cathodic Protection O Dewatering S O Heal Exchange %'�' P•+rt/�1= P O Injection %• O Monitoring � O Remediation ( O Sparging South O Test Well suss. a dupnt. a.u•e. pr ».n •om r•sd., an:a•,a•. Ln<•s O Vapor Extraction rro.n. uc. sndanamamap u11,4416 1pap•rirneces•ary Q Other AGRICULTURAL 35 250 /GREY KST 250 260 VELIWATER BEARING 270 IGREYDatum 280 LNVATER BEARING 280 305 SANDSTONE 305 320 BROWN SANDSTONE 320 380 SANDSTONE/GREY 380 405 BLUE GREY SAND CLAY 405 415 SMALL & LARGER GRAVELIWATER BEARING 415 440 SANDY CLAY Material Depth from Borehole Type Well Outside Material ThicknessDiameter Screen Slot Slze Type If Any Depth from Surface FII] Description Surface Diameter Feet to Feel pitches) Inches Inches Inches 1 --pular Feet to Ft...ee 3An I 440 IRS25 ] Screen I STEEL 10.188 16.625 I MIIled Slots 1 U.U15U _JI__- 1 1 1 1 ❑ Geologic Log ❑ Well Construction Diagram ❑ Geophysical Log(s) ❑ SollMater Chemical Analyses ❑ Other Attach additWtel IMOrrnaten d it atisla. DWR 188 REV. 112008 I, the t Name Signed 1� %f�� 1101171 as7 711 doe Water wen Contractor Date Sig IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM the best of my knowedge and pellet C� 95249 state Zip 017 #237647 Depth to first water 260 (Feet below surface) Depth to Static Water Level 330 (Feet) Date Measured 10113/2017 Estimated Yield ' 26 (GPM) Test Type Constant Rate Total Depth of Spring 440 Feet Test Length 4.0 _ (Hours) Total Drawdown (Feet) Total Depth of Completed Well 440 Feet Maxnot be re reseentalive of��a well's long term yield. Casings Material Depth from Borehole Type Well Outside Material ThicknessDiameter Screen Slot Slze Type If Any Depth from Surface FII] Description Surface Diameter Feet to Feel pitches) Inches Inches Inches 1 --pular Feet to Ft...ee 3An I 440 IRS25 ] Screen I STEEL 10.188 16.625 I MIIled Slots 1 U.U15U _JI__- 1 1 1 1 ❑ Geologic Log ❑ Well Construction Diagram ❑ Geophysical Log(s) ❑ SollMater Chemical Analyses ❑ Other Attach additWtel IMOrrnaten d it atisla. DWR 188 REV. 112008 I, the t Name Signed 1� %f�� 1101171 as7 711 doe Water wen Contractor Date Sig IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM the best of my knowedge and pellet C� 95249 state Zip 017 #237647