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'Tfie free Ado;Reader may be used to view and comp is form. However,software must be purchased to completE and reuse a saved form. <br /> File Original with DWR State of California DWR Use Only—Do Not Fill In <br /> Page 1 of 1 Well Completion Report <br /> Refer to Instruction Pamphlet <br /> Owner's Well Number MW-F No• e0354620 State Well Number/Site Number <br /> N W <br /> Date Work Began 06/21/2017 Date Work Ended 6/21/2017 Latitude Longitude <br /> Local Permit Agency San Joaquin County Environmental Health DeDartment I I I II I I I I I I <br /> Permit Number SR0077771 Permit Date 6/19/17 APNrrRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name John Taylor Fertilizer C/O Eric Jenks <br /> Driiiing tMethod Sonic Driiiing Fiuid None I <br /> Mailing Address PO Box 511 <br /> Depth from Surface Description I <br /> Feet to Feet Describe material,grain size,color,etc City Yuba City State CA lip 95991 <br /> 0 21 primarily silty clay. Well Location <br /> 21 34 primarily sand. Address 1819 S.Argonaut Street <br /> 34 40 primarily clay and silty clay. City Stockton County San Joaquin <br /> Latitude N Longitude W <br /> Deq. Min. Sec DP.q. Min. Sec. <br /> Datum NAD83 Dec. Lat. 37.93109930 Dec. Long._-121.303741FA <br /> APN Book 163 Page 200 Parcel 08 <br /> Townshi T1 t`1 Ran e R6E Section S15 <br /> Location Sketch Activ' <br /> Sketch must be drawn by hand after form is pnnted. O New Well <br /> North 0 Modification/Repair <br /> 0 Deepen <br /> 0 Other <br /> 0 Destroy <br /> Describe procedures and materials <br /> -&,'GEOLOGIC LOG' <br /> Planned Uses <br /> 0 Water Supply <br /> ❑Domestic []Public <br /> a w ❑Irrigation ❑Industrial <br /> 0 Cathodic Protection <br /> 0 Dewatering <br /> 0 Heat Exchange <br /> 0 Injection <br /> 0 Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> South 0 Test Well <br /> =ate or de—be distance of well from roads,buildings,fend 0 Vapor Extraction <br /> ,etc.and attach a map.Use additional paper if necessary f s 0 Other <br /> Please be accurate and com fete. <br /> Water Level and Yield of Completed Well <br /> Depth to first water 24 (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured 06/21/2017 <br /> Total Depth of Boring 40 Feet Estimated Yield` (GPM) Test Type <br /> Test Length (Hours) Total Drawdown (Feet) <br /> Total Depth of Completed Well 35 Feet •May not be representative of a well's long term yield. <br /> Casings I Annular Material <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material i mckness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 20 6 3/4 1 Blank PVC Sch.40 0.15 2 0 115 1 cement type 2 portland <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 #2112 sand <br /> 36 40 Bentonite hydrated 1/4"chips <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 Gregg Drilling&Testing. Inc <br /> Pe <br /> ❑ Geophysical Log(s) 950 Howe-d Finn or Corporation Martinez CA 94553 <br /> ❑ Soil/Water Chemical Analyses Add City State zip <br /> res <br /> ❑ Other Site Plan Signed / LID 10/17/2017 485165 <br /> Attach additional information if it exists. C-57 Icensed 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 />