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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 <br />State of California <br />Page 1 of 1 Well Completion Report <br />Refer to Instruction Pamphlet <br />Owner's Well Number #1 No. e0355064 <br />Date Work Began 10/16/2017 Date Work Ended 10/18/2017 <br />Local Permit Agency SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT, <br />Permit Number WP0037333 _ Permit Date 9/13/17 <br />DWR Use Only — Do Not Fill In <br />I I I I I <br />_ State Well Number/Site Number <br />I I I I -II I fwl <br />Latitude Lon itude <br />I I I I I I I I I I <br />APN/TRS/Other <br />Geologic Log <br />Well Owner <br />Orientation OVertical O Horizontal OAngle Speciry <br />Drilling Method Drilling Fluid <br />_ <br />Name JOE SCHENONE <br />Mailing Address 5256 NORTH CONFER ROAD <br />City STOCKTON State C_Zi 95215 <br />Depth from Surface Description <br />Feet to Feet Describe material, grain size color, etc <br />0 2 OVERBURDEN <br />Well Location <br />2 180 SANDSTONE <br />Address 27251 EAST HARNEY LANE <br />City LODI County San Joaquin <br />Latitude 38 7 _21 N Longitude 120 58 50ry <br />Dea. Min. Sec. Deo. Min. Sec. <br />Datum Decimal Lat. _ Decimal Long. <br />APN Book 067 Page 210 Parcel 01 <br />Township T3N Ranqe 9E Section 10 <br />180 260 SANDSTONE AND BREAKS <br />260 340 SANDSTONE AND SAND WATER BEARING <br />Location Sketch <br />Sketch must be drawn b hand after form is printed.) <br />Activity <br />(D New Well <br />O Modification/Repair <br />O Deepen <br />O Other <br />Q Destroy <br />procedures end materiels <br />under "GEOLOGIC LOG' <br />North —"i <br />y <br />1' f�Describe <br />r � <br />7` <br />W <br />�� is <br />/J 1 P <br />/ <br />% <br />wjLGL � <br />South <br />Planned Uses <br />Q Water Supply <br />[:]Domestic []Public <br />Irrigation Industrial <br />❑ ❑ <br />O Cathodic Protection <br />Q Dewatering <br />O Heat Exchange <br />je to n <br />O Monitoring <br />0 M <br />O Remediation <br />O Sparging <br />O Test Well <br />O Extraction <br />Q Other AGRICULTURAL <br />--- <br />Illustrate or describe distance of well from roads, buildings, lances, <br />rivers, etc. and attach a map. Use additional paper if necessary. <br />Please be accurate and con kte. <br />Water Level and Yield of Completed Well <br />Depth to first water 210 _ (Feet below surface) <br />Depth to Static <br />Water Level 210 (Feet) Date Measured 10/18/2017 <br />Estimated Yield * 45 (GPM) Test Type Constant Rate <br />Test Length _4.0 —__ (Hours) Total Drawdown (Feet) <br />*May not be representative of a well's long term yield. <br />Total Depth of Boring 340 Feet <br />Total Depth of Completed Well 34.0 Feet <br />Casings Annular Material <br />Depth from Borehole Type 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 <br />55 Cement PUMPED IN <br />_ <br />0 240 8,625 BLANK STEEL 0,156 6.625 <br />_ <br />240 340 8.625 Screen STEEL 0.188 6,625 Milled Slots 0.060 <br />Attachments <br />Certification Statement <br />❑ Geologic Log <br />❑ Well Construction Diagram <br />❑ Geophysical Log(s) <br />❑ Soil/Water Chemical Analyses <br />❑ Other <br />Attach additional information if It exists. <br />1, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief <br />Name BRISKI WELL GRILLING CO. INC. <br />_ <br />Person, Firm or Corporation <br />2918 HWY 12 SAN DREAS CA 95249 <br />Address City stale zip <br />Signed _ 10/18/2017 #237647 <br />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 />