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The free Adohe 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 /> Well Completion Report <br /> Page 1 Of 1 Refer to Instruction Pamphlet <br /> Owner's Well Number MW-C No• e0354617 State Well Number/Site Number <br /> -TN1 I J=Twl <br /> Date Work Began 06/30/2017 Date Work Ended 6/30/2017 Latitude Longitude <br /> Local Permit Agency San Joaquin County Environmental Health Deoartment I II I I I I I I I I <br /> Permit Number SR0077771 Permit Date 6/19/17 APNTFRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle Specify Name John Taylor Fertilizer c/o Eric Jenks <br /> Driiiing Method Sonic Drilling Fluid iJone <br /> Mailing Address PO Box 511 I <br /> Depth from Surface Description <br /> Feet to Feet Describe material,grain size,color,etc City Yuba City State CA lip 95991 <br /> 0 22 primaril silt with clay and sand Well Location <br /> 22 25 primarily sand with silt. Address 1819 S.Argonaut Street <br /> 25 35 primarily sand City Stockton County San Joaquin <br /> 35 40 primarily clay Latitude N Longitude w <br /> 40 50 primarily silt with clay and sand Deq. Min Sec. Deq, Min Sec, <br /> 50 57 primarily sand with silt Datum NAD83 Dec.Lat. 37.93152120 Dec.Long.-121.30405636 <br /> 57 69 primarily silt with clay and sand APN Book 163 Page 200 Parcel 08 <br /> 69 78 primarily silty sand 1 Township T1 N Range R6E Section S15 <br /> 78 89 primarily sand Location Sketch Activity <br /> 89 95 primarily clay Sketch must be drawn b hand after form is printed Oi New Well <br /> North p Modification/Repair <br /> O Deepen <br /> O Other <br /> O Destroy <br /> Describe procedures and matenals <br /> under"P.,M." LOG' <br /> Planned Uses <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> w ❑Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> 0 Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> Illustrate or describe distance of well from roads,buildings,fences, <br /> O Vapor Extraction <br /> ,etc and attach a map.Use additional paper if necessary.s p Other <br /> Please be accurate and- fete. <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 06/30/2017 <br /> Total Depth of Boring 95 Feet Estimated Yield* (GPM) Test Type <br /> Test Length (Hours) Total Drawdown (Feet) <br /> Total Depth of Completed Well 88 Feet *May not be representative of a well's long term yield. <br /> Casings Annular Material <br /> Depth from Borehole WaII Outside Screen Slot Size Depth from <br /> Tvoe Material <br /> Surface Diameter Thickness Diameter Type if Any Surface Fiii Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 68 4 Blank PVC Sch.40 0.15 2 0 64 1 Cement type 2 por land <br /> 68 88 4 Screen PVC Sch.40 0.15 2 Slotted 0.010 64 66 Bentonite hydrated 1/4"chips <br /> 66 89 Filter Pack #2/12 sand <br /> 89 95 Bentonite hydrated 1/8"chips <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 /> El Well Construction Diagram Name Gregg Drilling&Testing, Inc <br /> Person,Firm or Corporation <br /> ❑ Geophysical Log(s) 950 Howe Rd Martinez CA 94553 <br /> ❑ Soil/Water Chemical Analyses Address City State zip <br /> ❑ Other Site Plan Signed %d - 10/17/2017 485165 <br /> Attach additional information if it exists / C-57 Lice ed 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 />