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*The free Adot e 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 with DWR State of California DWR Use Only—Do Not Fill In <br /> Page 1 of 1 Well Completion Report <br /> g Refer to Instruction Pamphlet <br /> Owner's Well Number MW-E No. e0354619 State Well Number/Site Number <br /> N IyU <br /> Date Work Began 06/21/2017 Date Work Ended 6/22/2017 Latitude Longitude <br /> Local Permit Agency San Joaquin County Environmental Health Department <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 /> Chilling Method Sonic Drilling Fluid 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 Zip 95991 <br /> 0 127 primarily silty clay. Well Location <br /> 27 34 primarily sand. Address 1819 S.Argonaut Street <br /> 34 36 primarily clay. City Stockton County San Joaquin <br /> Latitude N Longitude W <br /> DeQ. Min, Sec. Deq_ Min. Sec. <br /> Datum NAD83 Dec.Lat. 37.93155460 Dec.Long.-121.304056(ii <br /> APN Book 163 Page 200 Parcel 08 <br /> Township T1 N Ran e R6E Section S15 <br /> Location Sketch Activity <br /> Sketch must be drawn by hand after form is anted. Oi New Well <br /> North <br /> Q Modification/Repair <br /> Q Deepen <br /> O Other <br /> Q Destroy <br /> Describe procedures and matenals <br /> under"GEOLOGIC LOG" <br /> Planned Uses <br /> Q Water Supply <br /> 0Domestic ❑Public <br /> w ❑Irrigation [Industrial <br /> Q Cathodic Protection <br /> O Dewatering <br /> Q Heat Exchange <br /> Q Injection <br /> 0 Monitoring <br /> Q Remediation <br /> O Sparging <br /> South (0 Test Well <br /> Illustrate or describe distance o/w,It from roads,buildings,fences, v Vapor Extraction <br /> rivers,etc.and attach a map.Use additional paper if necessary. Q Other <br /> Please be accurate and complete, <br /> Water Level and Yield of Completed Well <br /> Depth to first water 10 (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured 06/22/2017 <br /> Total Depth of Boring 36 Feet Estimated Yield* (GPM) Test Type <br /> Test Length (Hours) Total Drawdown (Feet) <br /> Total Depth of Completed Well 35 Feet *MaV not be representative of a well's long term yield- <br /> Casings Annular Material <br /> Depth from Borehole Tvp. Mafarial Wall Outside Screen Slot Size Depth from <br /> Surface Diameter """-'"' Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 25 6 3/4 Blank PVC Sch.40 0.15 2 0 20 Cement type 2 portland <br /> 25 35 6 3/4 Screen PVC Sch.40 0.15 2 Slotted 0.010 20 23 Bentonite hydrated 1/4"chips <br /> 23 36 Filter Pack #2/12 sand <br /> Attachments Certification Statement <br /> 0 Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> 0 Well Construction Diagram Name Gregg Drilling Testing, Inc <br /> El Geophysical Log(s) 950 Howe-Rd Fi m or Corporation Martinez CA 94553 <br /> ❑ Soil/Water Chemical Analyses �4ddress City State zip <br /> ❑� Other Site Plan Signed i /f 10/17/2017 485165 <br /> Attach additional information if it exists. C-57 L tensed Water Well Contractor Date Signed C-57 License Number <br /> DWR 186 REV,1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />