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'The free Adobe Reader may be used to view and compl 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 /> Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number MW-D No• e0354618 <br /> N W <br /> Date Work Began 07/03/2017 Date Work Ended 7/5/2017 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 O Vertical O Horizontal OAngle Specify Name John Taylor Fertilizer c/o Eric Jenks <br /> Driiiirig lMlethod Sonic Driiiing Fluid "voile I <br /> Depth from Surface Description I Mailing Address PO Box 511 <br /> Feet to Feet Describe material,grain size,color,etc City Yuba City State CA zip 95991 <br /> 0 20 primarily clay. Well Location <br /> 20 28 primarily sand. Address 1819 S.Argonaut Street <br /> 28 44 primarily clay. City Stockton County San Joaquin <br /> 44 55 primarily sand with silt. Latitude N Longitude W <br /> 55 59 primarily sand. Dec Min. Sec. Deo Min Sec <br /> 59 66 primarily silt with clay and sand. Datum NAD83 Dec. Lat. 37.93109000 Dec. Long.-121.303518% <br /> 66 78 primarily sand. APN Book 163 Page 200 Parcel 08 <br /> 78 80 primarily clay. 1 Township T1 N Range R6E Section S15 <br /> Location Sketch IActivity <br /> Sketch must be drawn by hand after form isprinted.) Qi New Well <br /> North 0 Modification/Repair <br /> O Deepen <br /> 0 Other <br /> 0 Destroy <br /> Describe procedures and materials <br /> under GEOLOGIC LOG' <br /> Planned Uses <br /> 0 Water Supply <br /> ❑Domestic []Public <br /> 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 /> Illustrate or describe dstance of wen from roads,buildings,fences, 0 Vapor Extraction <br /> rners,etc.and attach a map.Use additional paper if necessary. 0 Other <br /> Please be accurate and cold lete. <br /> Water Level and Yield of Completed Well <br /> Depth to first water 20 (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured 07/05/2017 <br /> Total Depth of Boring 80 Feet Estimated Yield` (GPM) Test Type <br /> Test Length (Hours) Total Drawdown (Feet) <br /> Total Depth of Completed Well 78 Feet -may 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 /> aCE Type Material Diameter Thickness Diar(I@ter Type If Mrly Surface FIII Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 58 4 Blank PVC Sch.40 0.15 2 0 53 Cement type 2 portland <br /> 58 78 4 Screen PVC Sch.40 0.15 2 Slotted 0.010 53 56 Bentonite hydrated 1/4"chips <br /> 56 80 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 /> ❑Well Construction Diagram Name Gregg Drilling t£Testing, Inc <br /> El Geophysical Log(s) Person,Finn or Corporation <br /> 950 Howe Rd Martinez CA 94553 <br /> ❑ Soil/Water Chemical Analyses Address City State zip <br /> ❑ Other Site Plan Signed 11 10/17/2017 485165 <br /> Attach additional information if it exists. C-57 Li Onset ater 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 />