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'Thfe free Adobe Reader may be used to view and complc 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 Refer to Instruction Pamphlet State Well Number/Site Number Owner's Well Number IW-F No. e0354615 N w Date Work Began 06/28/2017 Date Work Ended 6/29/2017 Latitude Longitude Local Permit Agency San Joaquin County Environmental Health Department Permit Number SR0077771 Permit Date 6/19/17 APN/TRS/Other Geologic Log Well Owner Orientation OVertical O Horizontal OAngle Specify Name John Taylor Fertilizer c/o Eric Jenks Drilling Method Sort c D,.:ll'ng Fluid NGn c Mailing Address PO Box 511 Depth from Surface Description Yuba City CA 95991 I Feet to Feet Describe material, rain size,color,etc City State Zip 0 22 primarily clay and sandy clay- Well Location 22 30 primarily sand. Address 1819 S.Argonaut Street 30 48 primarily clay. City Stockton County San Joaquin 48 49 sand seam Latitude N Longitude W 49 77 primarily clay and sandy clay. Deg Min sec pea Min sec 77 79 sand seam Datum NAD83 Dec.Lat. 37.93134370 Dec.Long.-121.303525% 79 85 primarily clay. APN Book 163 Page 200 Parcel 08 Township T1 N Range R6E Section S15 Location Sketch Activity Sketch must be drawn by hand after form is printed. Q 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 (j) Injection O 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 allach a map.Use additional paper if necessary, p Other Please be accurate and com lete. Water Level and Yield of Completed Well Depth to first water 22 (Feet below surface) Depth to Static Water Level (Feet) Date Measured 06/29/2017 Total Depth of Boring 85 Feet Estimated Yield" (GPM) Test Type Total Depth of Completed Well 80 Feet Test Length (Hours) Total Drawdown (Feet) -May not be representative of a well's long term yield- Casings 11 Annular Material Depth from Borehole Wall Outside Screen Slot Size Depth from Surface D a-- Type Material _ __ _ _____ _ Type f A(y $iitinCC Fiii Description Feet to Feet Inches( (Inches (Inches)( Inches Feet to Feet 0 65 6 3/4 1 Blank PVC Sch.80 0.15 2 0 161 Cement type 2 portland 65 80 6 3/4 Screen 80 Stainless Steel 0.15 2 Wire Wrap 0.010 61 63 Bentonite hydrated 1/4"chips 63 81 Filter Pack #2/12 sand 81 85 Bentonite hydrated 1/4"chips Attachments Certification Statement 0 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 ElGeophysical LO Person,Firm or Corporation g(S) 950 Howe Rd Martinez CA 94553 ❑ Soil/Water Chemical Analyses Address City State zip ❑� Other Site Plan Signed 10/17/2017 485165 Attach additional information if it exists. C-57 Licenlbd W ter Well Contractor Date Signed C-57 License Number DWR 188 REV.1/2006 IF ADDITIONAL SPACE�IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM