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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 1 Of 1 Refer to Instruction Pamphlet <br /> State Well Number/Site Number <br /> Owner's Well Number No.xxxxxxx I FTNIW <br /> Date Work Began Date Work Ended Latitude Longitude <br /> Local Permit Agency <br /> Permit Number Permit Date APNfTRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name Gallo Vineyards <br /> Drilling Method Drilling Fluid <br /> Mailing Address <br /> Depth from Surface Description <br /> Feet to Feet Describe material,grain size,color,etc City State 7i <br /> 0 4 _Top soil Well Location <br /> 6 Clay Address <br /> 56 82 Clay with sand City Acamoo County <br /> 82 123 Clay Latitude N Longitude <br /> 123 03 and with clay Dea. Min. Sec. Deq. Min. Sec. <br /> 03 244 lay Datum Decimal Lat. Decimal Long. <br /> 244 277 Clay with sand APN Book Page Parcel <br /> 77 462 Silty clays Township -Range Section <br /> 62 497 Dark brown silty clay with sand stringers Location Sketch Activit <br /> 97 03 Light gray clay with sand stringers Sketch must be drawn N haltnd after form is printed.) Qi New Well <br /> 503 63 Blueish gray clay with some mudstone rtO O Deepen <br /> Repair <br /> 763 1020 Blue clay O Other- <br /> 0 <br /> troy <br /> 1020 1260 Silty blue clay O D@Sdbe procedures and materials <br /> 1260 1460 Blue silty clay with sand stringers under"GEOLOGIC LOG" <br /> 1460 1583 Black sands with traces of brown and white sand Planned Uses <br /> 1583 1612 Blue silty clay with sand stringer O Water Supply <br /> ❑Domestic []Public <br /> w ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South 0 Test Well <br /> Illustrate or describe dlslance of well from roads,buildings,fences, <br /> O Vapor Extraction <br /> rivers,etc.and attach a .mapUse additional paper if necessary. O Other <br /> Please be accurate and.., <br /> late. <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 1612' Feet Estimated Yield* (GPM) Test Type <br /> Total Depth of Completed Well 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 Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <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 <br /> El Geophysical Log(s) Person,Firm or Corporation CA <br /> ❑ Soil/Water Chemical Analyses Address city state Zip <br /> ❑ Other Signed <br /> Attach additional information if it exists. C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />