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`The free Adobe Reader may be used to view and complc 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 IW-E No. e0354614 <br /> N W <br /> Date Work Began 06/20/2017 Date Work Ended 6/22/2017 Latitude Longitude <br /> Local Permit Agency San Joaquin County Environmental Health DeDartment 1 <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 /> Drilling Method Sonic Drilling Fluid None <br /> Mailing Address PO Box 511 <br /> Depth from Surface Description <br /> Feet to Feet Describe material,grain size,color,etc city Yuba City State CA Zip 95991 <br /> 0 25 primarily silty clay. Well Location <br /> 25 40 primarily sand. Address 1819 S.Argonaut Street <br /> 40 45 primarily silty sand. City Stockton County San Joaquin <br /> 45 47 primarily clay with silt. Latitude N Longitude w <br /> 47 50 primarily silty Sand. Dec. Min Sec- Dec. Min Sec, <br /> 50 57 primarily clay. Datum NAD83 Dec.Lat. 37.93123980 Dec. Long.-121.304047Czi <br /> 57 60 primarily sand. APN Book 163 Page 200 Parcel 08 <br /> 60 70 primarily clay. I Township T1 N Range R6E Section S15 <br /> 70 76 primarily silty clay. Location Sketch Activity <br /> 76 91 primarily Sand. Sketch must be drawn by hand after form is printed Oi New Well <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> p Destroy <br /> Describe procedures and materials <br /> under'GEOLOGIC 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 /> 0 Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> South (0 Test Well <br /> Illustrate or describe distance mwell from roads,buildings,fences, v vapor Extraction <br /> ,etc.and attach a map.Use additional paper if necessary. O Other <br /> Please be accurate and­Pete <br /> IN I <br /> Water Level and Yield of Completed Well <br /> Depth to first water 25 (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured 06/22/2017 <br /> Total Depth of Boring 91 Feet Estimated Yield` (GPM) Test Type <br /> Total Depth of Completed Well 91 Feet Test Length (Hours) Total Drawdown (Feet) <br /> *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 /> Su f�sa ......... Type Material -- er e <br /> TYpc if:,�ry $iiriaGe Fiii uesaription <br /> Feet to Feet Inches (inches (Inches( Inches Feet to Feet <br /> 0 75 6 3/4 Blank PVC Sch.80 0.15 2 0 70 Cement type 2 portland <br /> 75 90 6 3/4 Screen 80 Stainless Steel 0.15 2 Wire Wrap 0.010 70 73 Bentonite hydrated 1/4"chips <br /> 73 91 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 cY�Testing. Inc <br /> ElGeophysical LO Person,Firm or Corporation <br /> g(S) 950 Howe Rd Martinez CA 94553 <br /> ❑ Soil/Water Chemical Analyses 7 Address City state zip <br /> 0 Other Site Plan Signed � 10/17/2017 485165 <br /> Attach additional information if it exists. C-57 Li nsed Water Well Contractor Date Signed C-57 License Number <br /> DWR 188 REV.112006 IF ADDITIONAL SPA6E IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />