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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. File Original with DWR State of California DWR Use Only—Do Not Fill In Page 1 of 1 Well Completion Report g Refer to Instruction Pamphlet State Well Number/Site Number Owner's Well Number MW-B No• eO354616 N w Date Work Began 06/30/2017 Date Work Ended 6/30/2017 Latitude Longitude Local Permit Agency San Joaquin County Environmental Health Department II I I I I I I I Permit Number SR0077771 Permit Date 6/19/17 APN/TRS/Other Geologic Log Well Owner Orientation O Vertical O Horizontal OAngle Specify Name John Taylor Fertilizer c/o Eric Jenks Dr1111nn�Aethod Sonic Drilling Fluid n y b„,y uld None Mailing Address PO Box 511 I Depth from Surface Description Feet to Feet Describe material, rain size,color,etc City Yuba City State CA lip 95991 0 22 primarily silt with clay. Well Location 22 33 primarily sand with silt. Address 1819 S. Argonaut Street 33 45 primarily clay. City Stockton County San Joaquin 45 59 primarily silt with clay and sand. Latitude N Longitude w 59 79 primarily silt with sand. Den. Min sec Dea Min. sec. 79 81 primarily clay. Datum NAD83 Dec. Lat. 37.93110590 Dec.Long.-121.30449691 APN Book 163 Page 200 Parcel 08 ,Township 11 N Range 36E Section S15 Location Sketch Activity (Sketch must be drawn by hard after form isprinted.) Qi New Well North O Modification/Repair O Deepen O Other O Destroy Describe procedures and materials under'GEOLOGIC LOG' Planned Uses O Water Supply ❑Domestic [—]Public w ❑Irrigation ❑Industrial O Cathodic Protection O Dewatering O Heat Exchange O Injection Q Monitoring O Remediation O Sparging South O Test Well Illustrate or describe distance of well from roads,buildings,fences. O vapor Extraction rivers,etc.and attach a map.Use additional paper if necessary. O Other Please be accurate and-fete, Water Level and Yield of Completed Well Depth to first water 10 (Feet below surface) Depth to Static Water Level (Feet) Date Measured 06/30/2017 Total Depth of Boring 81 Feet Estimated Yield` (GPM) Test Type Total Depth of Completed Well 80 Feet Test Length (Hours) Total Drawdown (Feet) `Ma not be re resentative of a well's long term yield. Casings Annular Material Depth from Borehole Wall Outside Screen Slot Size Depth from ,,., Type Material _ p_ Feet to yFeet V Inches r r(�� (a �.� Type „Ily ou'-face r(rr Description (Inches (Inches)( Inches Feet to Feet 0 60 6 3/4 Blank PVC Sch.40 0.12 2 0 55 Cement type 2 Portland 60 80 6 3/4 Screen PVC Sch.40 0.12 2 Slotted 0.010 55 58 Bentonite hydrated 1/4"chips 58 81 Filter Pack #2/12 sand Attachments Certification Statement Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief ❑� Well Construction Diagram Name Gregg Drilling&Testing, Inc ❑ Geophysical Log(s) Person,Firm or Corporation 950 Howe Rd Martinez CA 94553 ❑ Soil/Water Chemical Analyses Address City State zip ❑ Other Site Plan Signed �� Lf` 10/17/2017 485165 Attach additional information if it exists. C-5� 7 Licens ate'Well Contractor - Date Signed C-57 License Number DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM