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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 farm File Original with DWR State of California DWR Use Ont —DoNot Fill In Page of Well Completion Report Refer to Instruction Pamphier State Well NumberlSite Number Owner's Well Number No. e02954013 N Iw Date Work Began date Work Ended 11/512015 Latitude Longitude Local Permit Agency SAN JOAQUIN COUNTY = I I I I I I Permit Number SR 072764 Permit Date 7/27/15 APNITRS1Other Geologic Log Well Owner Orientation OVertical O Horizontal OAn le Specify_g Name HYTY VENTURES Drilling Method CABLE Drilling Fluid Mailing Address 1513 RIVER OAKS Depth from Surface Description Feet to Feet Describe material,grain size,color,etc City MODESTO State CA-zip 95356 0 3 BROWN SANDY CLAY Well Location 3 115 HARD BROWN CLAY Address 20012 CLEMENTS ROAD 15 45 GRAVEL&SANDY BROWN CLAY City LODI County San Joaquin 45 62 BROWN HARD CLAY _ Latitude N Longitude Jnr 62 75 LARGE ROCKS IN CLAY Dec. Min. Sec Dec Mm Sec 75 240 TAN CLAY Datum Dec. Lat. Dec-tong_ 240 1250 GRAY SAND APN Book Page Parcel 023-05-004 250 290 BROWN HARD CLAY Townshi —Range Section 290 320 LAYERED BLACK SAND&HARD BROWN CLAY Location Sketch Activity 320 445 BLACK ROCKY SANDSTONE= {Sketch must be drawn b hand after form is r med) Q New Well 445 455 SOFT BROWN SANDSTONE North (? Modification/Repair Q Deepen 455 480 HARD BROWN SANDSTONE Ut o Other 480 485 GRAY SAND O Destroy describe procedures antl materials 485 565 HARD BROWN SANDSTONE t under cFarocic oc 565 580 BROWN SILTY CLAY Planned Uses 580 640 BROWN CHUNKY CLAY Q Water Supply 640 645 BLACK SANDN ❑Domestic ❑Public ❑Irrigation []Industrial 645 705 BROWN CHUNKY CLAY Cathodic Protection 705 740 BROWN SANDSTONE Q 0 © Dewatering 740 750 COURSE BLUE-GRAY SAND Q Heat Exchange 750 SANDSTONE 4 O Injection f O Monitoring or I; O Remediation 7 fl Sparging O Test Well ellus"e os describe dotar ofrn 11 frau roaft txwda�,rences. © Vapor Extraction rivers.etc aria attacn a map.uae Iiilionel pipet 1lnccessary 0 Other PI«ase ba accwale and 1 11 ENVIRUNMENTAL HEALTH Water Level and Yield of Completed Well FERMMSERMCES Depth to first water 237 (Feet below surface) Depth to Static Water Level (Feet) Date Measured Total Depth of Boring 750 Feet Estimated Yield" (GPM) Test Type Total Deplh of Completed Well 750 Feet Test Length (Hours) Total Drawdown (Feet) *May not be representative of a well's long term yield. Casings Annular Material Depth from Borehole Mall Outside Screen Slot Size Depth from Surface Diameter Type Material Thickness Diameter Type if Any Surface Fill Description Feet to Feet Inches Inches Inches Inches Feet to Feet 0 50 20 Blank Low Carbon steel 188 14 0 50 Cement 10.3 sand slurry 50 330 14 Blank Low Carbon Steel 188 14 440 480 10 314 Perforated Low Carbon Steel 188 103/4 480 600 10 314 Blank Low Carbon Steel 188 103/4 Attachments Certification Statement ❑Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief Well Construction Diagram Name KEN GROSS PUMP SERVICE Person,Fri❑Geophysical Logs) 353 N. LINCOL I SWAY anon GALT CA 95632 ❑ Soili Chemical Analyses I / A city sate Zip ❑ Other Signed �f`'}fi 12/29/2015 530672 Attach additional information d it emsts C-57 l i—wd water won ontra o Date Signed C-57 License Number DwR 185 REV.1/1006 iF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM