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`The free Adobe Reader may be used to view and complete this form. However,software must be purchased to complete,save,and reuse a saved form. <br /> File Original with DWR State of California DWR Use Only—Do Not Fill In <br /> Well Completion Report <br /> Page Of Refer to Instruction Pamphlet <br /> State Well Number/Site Number <br /> Owner's Well Number L108 MP 47.06 No. <br /> e0365012 1 1 1 N I I I I IW <br /> Date Work Began 12/13/2017 Date Work Ended 12/15/2017 Latitude Longitude <br /> Local Permit Agency San Joaauin Envirommnetal Health DeDartment <br /> Permit Number SR0074399 Permit Date 3/11/17 APN/TRS/Other <br /> Geologic Log Well Owner(confidential pursuant to CA Water Code 13752) <br /> Orientation OVertical 0Horizontal OAngle Specify Name PG&E <br /> Drilling Method Direct Rotary Drilling Fluid Bentonite mud Mailing Address PO Box 7760 <br /> Depth from Surface Description <br /> Feet to Feet Describe material,grain size,color,etc City San Francisco State CA _Zip 94120 <br /> 0 5 Dark Brown Sandy Clay Well Location <br /> 5 55 Lt Brown Silt and Sand Address .7 mi S/O 2401 Kile Rd <br /> 55 110 Gravels up to 1" City Lodi County San Joaquin <br /> 110 140 Reddish Brown Clay with Sand Latitude N Longitude W <br /> 140 160 Light Brown Sandy Clay Deo in Sec Deq Min Sec <br /> 160 200 Reddish Brown Clay Datum Dec. Lat. Dec.Long. <br /> APN Book 001 Page 25 Parcel 006 <br /> Township —Range Section <br /> Location Sketch Activity <br /> 0 New Well <br /> 0 Modification/Repair <br /> 0 Deepen <br /> O Other <br /> — <br /> 0 Destroy <br /> Describe procedures and materials <br /> under'GEOLOGIC LOG' <br /> Planned Uses <br /> 0 Water Supply <br /> [:]Domestic ❑Public <br /> LOCATION 1 g []irrigation ❑Industrial <br /> SNfnC <br /> G Cathodic Protection <br /> 0 Dewatering <br /> KnEao. 0 Heat Exchange <br /> 0 Injection <br /> 0 Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> 0 Test Well <br /> \ 0 Vapor Extraction <br /> 0 Other <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 205 Feet Estimated Yield` (GPM) Test Type <br /> Total Depth of Completed Well 200 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 T Material wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 100 10 Blank PVC Sch.40 2.375 0 196 1 Cement <br /> 100 200 10 Screen PVC Sch.40 2.375 Milled Slots 0.050 96 205 1 Fill Coke Breeze <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 Greqq Drilling&Testing Inc <br /> Person,Finn or Corporation <br /> ❑ Geophysical Log(s) 950 Howe Rd Marinez CA 94553 <br /> ❑ Soil/Water Chemical Analyses Ad ess,^� -City State zip <br /> El Other Signedy1 r 3/22/2018 485165 <br /> Attach additional information if it exists. 57 Lice ed Water Well Contractor Date Signed C-57 License Number <br /> DWR 188 REV.212017 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />