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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 No. e0355384 I I w <br /> Date Work Began 09/20/2017 Date Work Ended 9/29/2017 Latitude Longitude <br /> Local Permit Agency San Joaquin Environmental Health Debt. I I JI <br /> I I__ I_ I I <br /> Permit Number 37335 Permit Date 9/19/17 APNfTRS/Other <br /> Geologic Log Well Owner <br /> Orientation OVertical OHorizontal OAngle Specify Name Brocchini Farms <br /> Drilling Method mud rotary Drilling Fluid Bentonite mud <br /> Mailing Address 27011 S.Austin Rd. <br /> Depth from Surface Description Ripon CA 95366 <br /> Feet to Feet Describe material, rain size,color,etc CI State_Zi <br /> 0 10 sand Well Location <br /> 10 18 clay Address 1455 S. Mohler Rd. <br /> 18 25 sand City Ripon County San Joaquin <br /> 25 30 clay Latitude N Longitude �N <br /> 30 32 sand Dec. Min. Sec. Deq. Min. Sec. <br /> 32 36 clay Datum Dec.Lat. Dec.Long. <br /> 36 42 sand APN Book 2_5 Page 270 Parcel 71 <br /> 42 56 clay Township Range Section <br /> 56 72 sand Location Sketch Activity <br /> 72 95 clay Sketch must be drawn by hand after form is printed.) O' New Well <br /> lt <br /> 95 97 sand O Modification/Repair <br /> O Deepen <br /> 97 114 clay O Other <br /> 114 117 isand O Destroy <br /> Desaitx procedures and materials <br /> 117 146 Clay unaer'GEOLOGIC LOG' <br /> 146 150 sand Planned Uses <br /> Q Water Supply <br /> 150 236 clay Domestic ❑Public <br /> ca 236 238 sand <br /> 238 246 clay w ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> 246 258 sand <br /> 0 Dewatering <br /> 258 260 Clay O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> Illustrate or describe distance of well from roads,buildings,fences, O Vapor Extraction <br /> rs etc.and attach a map. Use additional paper if necessary O Other <br /> Please be accurato and corn tete. <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level 33 (Feet) Date Measured <br /> Total Depth of Boring 260 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well 260 Feet <br /> Test Length (Hours) Total Drawdown (Feet) <br /> 'Ma not be re resentative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole T e Material wall Outside Screen Slot Size Depth from <br /> Surface Diameter yp Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet (Inches) Inches Inches Inches Feet to Feet <br /> 0 220 14 blank PVC 322 8 screen 0.050 0 1112 1 quik grout <br /> 220 i 1260 114 screen PVC .322 8 screen 0.050 112 260 No 6 sand pack <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 Hennings Bros Drilling Co. Inc. <br /> ElGeophysical LogPerson,Finn or Corporation s) 1930 Ladd d. Modesto CA 95356 <br /> ❑ Scil/Water Chemical AnalysesAa es City State zip <br /> ❑'Other Signed 10/19/2017 290813 <br /> Attach additional information if it exists. C-57 Aicensed Water Well Coftact6r If Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPASE IS NEEDED,USE NEXT CONSEC tt <br /> LY NUMBERED FORM <br />