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The free Adobe Reader may be used to view and comp) s form. However,software must be purchased to complete and reuse a saved form. <br /> File Original vpth DWR State of California DWR Use Only—Do Not Fill In <br /> Page 1 of 1 Well Completion Report <br /> Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owners Well Number MW-G No. e0354621 J- JNJ III W <br /> Date Work Began 06/26/2017 Date Work Ended 6/27/2017 Latitude Longitude <br /> Local Permit Agency San Joaquin County Environmental Health DeDartment <br /> Permit Number SR0077771 Permit Date 6/19/17 APN/TRS/Other <br /> Geologic Log Well Owner <br /> Orientation OVertical O Horizontal OAngle Specify Name John Taylor Fertilizer c/o Eric Jenks <br /> Drilling Method Sonic Drlfing Fluid None <br /> Depth from Surface Description Mailing Address PO Box 511 <br /> Feet to Feet Describe material,grain size,color,etc City Yuba City State CA zip 95991 I <br /> 0 25 primarily Silty clay and clay with silt. Well Location <br /> 25 30 primarily sand. Address 1819 S.Argonaut Street <br /> 30 36 primarily clay. City Stockton County San Joaquin <br /> Latitude N Longitude w <br /> DeQ. Min. Sec. Deci. Min. Sec. <br /> Datum NAD83 Dec.Lat. 37.93194050 Dec.Long.-121.30317&K <br /> APN Book 163 Page 200 Parcel 08 <br /> Township 11 N Range R6E Section S15 <br /> Location Sketch Activity <br /> Sketch must be drawn by hard after forth is rinted. 0New Well <br /> North <br /> Q Modification/Repair <br /> O Deepen <br /> O Other <br /> Q Destroy <br /> Des«ibe procedures and materials <br /> under'GEOLOGIC LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic []Public <br /> w ❑Irrigation ❑Industrial <br /> ENMRONMENTAL HEALTH <br /> PERhtIT/SER'JICE;; O Cathodic Protection <br /> Q Dewatering <br /> O Heat Exchange <br /> Q Injection <br /> E) Monitoring <br /> O Remediation <br /> Q Sparging <br /> South O Test Well <br /> Illustrate«describe distance of wen from roads,buildings,fences, O vapor Extraction <br /> rivers,etc.and adach a map,the additional paper if necessary. Q Other <br /> Please be accurate and com <br /> Water Level and Yield of Completed Well <br /> Depth to first water 25 (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured 06/27/2017 <br /> Total Depth of Boring 36 Feet Estimated Yield` (GPM) Test Type <br /> Total Depth of Completed Well 30 Feet Test Length (Hours) Total Drawdown (Feet) <br /> L:22y 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 D:ametter Type Material Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 20 6 3/4 Blank PVC Sch.40 0.15 2 0 15 Cement type 2 porttand <br /> 20 35 6 3/4 Screen PVC Sch.40 0.15 2 Slotted 0.010 15 18 Bentonite hydrated 1/4"chips <br /> 18 36 Filter Pack #2/12 sand <br /> Attachments Certification Statement <br /> [D 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 Gregg Drilling&Testing, Inc <br /> Pe <br /> ❑ Geophysical Log(s) 950 Howersod Firm or corporation Martinez CA 94553 <br /> ❑ Soil/Water Chemical Analyses 111 ddress City State zip <br /> I] Other Site Plan Signed O - 10/17/2017 485165 <br /> Attach additional information if it exists. C-57 lcensed Water Well Contractor oPr Date Signed C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />