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The free Adobe Reader may be used to view and comply form. However,software must be purchased to complete, and reuse a saved form. <br /> File Original with DWR State of California DWR Use Onl —Do Not Fill In <br /> Page 1 of 1 Well Completion Report <br /> g Refer to Instruction Pamphlet <br /> Owner's Well Number IW-D No- e0354613 State Well Number/Site Number <br /> N W <br /> Date Work Began 06/20/2017 Date Work Ended 6/23/2017 _ Latitude Longitude <br /> Local Permit Agency San Joaquin County Environmental Health Department [ I I I I I I I I <br /> Permit Number SR0077771 Permit Date 6/19/17 APNrIRS/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 /> Depth from Surface Description I Mailing Address PO Box 51 1 I <br /> Feet to Feet Describe material,grain size,color,etc City Yuba City State CA lip 95991 <br /> 0 25 rimarily silty clay. Well Location <br /> 25 28 primarily sandy clay. Address 1819 S.Argonaut Street <br /> 28 33 primarily sand. City Stockton County San Joaquin <br /> 33 40 primarily silty clay with sand. Latitude N Longitude W <br /> 40 60 primarily sandy clay and clay with sand. Dea. Min. Soo. Dea. Min, Sec <br /> 60 70 primarily clay and sandy clay. Datum NAD83 Dec.Lat. 37.93091880 Dec.Long. -121.303758(h <br /> 70 90 primarily sand. APN Book 163 Page 200 Parcel 08 <br /> 90 100 primarily clay. 1 Township T1N Range 36E Section S15 <br /> Location Sketch Activity <br /> Sketch must be drawn by hand after form is printed. 0 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 /> 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 /> nwsbate or describe distance of well from roads,buildings,fences, 0 Vapor Extraction <br /> rivers,etc and attach a map_Use additional paper if necessary. 0 Other <br /> Please be accurate and com Mete. <br /> Water Level and Yield of Completed Well <br /> Depth to first water 28 (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured 06/23/2017 <br /> Total Depth of Boring 100 Feet Estimated Yield' (GPM) Test Type <br /> Test Length (Hours) Total Drawdown (Feet) <br /> Total Depth of Completed Well 90 Feet May not be representative of a well's long term fold. <br /> Casings Annular Material <br /> Depth from Borehole Wall Outside Screen Slot Size 11 Depth from <br /> Su ace D'am�2r Type Material - __-- - -- _ <br /> Types if Arry Surface Fiii Description <br /> Feet to Feet Inches Inches' Vlnches r Inches Feet to Feet <br /> 0 70 6 3/4 1 Blank PVC Sch.80 0.15 2 0 165 Cement type 2 portland <br /> 70 90 6 3/4 Screen 80 Stainless Steel 0.15 2 Wire Wrap 0.010 65 68 Bentonite hydrated 1/4"Chips <br /> 68 91 Filter Pack #2/12 sand <br /> 91 100 Bentonite hydrated 1/4"Chips <br /> Attachments Certification Statement <br /> ❑� Geologic Log 1,the undersigned,certi that this report is complete and accurate to the best of my knowledge and belief <br /> ❑� Well Construction Diagram Name Gregg Drilling Testing, Inc <br /> ❑ Geophysical Log(s) 950 Howe Rn,Firm or co po ation Martinez CA 94553 <br /> ❑ Soil/Water Chemical Analyses ldress City State zip <br /> 0 Other Site Plan Signed -1 10/17/2017 485165 <br /> Attach additional Information if it exists. C-57 Li sed 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 />