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ThA free Adobe Reader may be used to view and comple 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 Well Completion Report Page 1 of 1 Refer to Instruction Pamphlet State Well Number/Site Number Owner's Well Number IW-C No. e0354612 Date Work Began 06/26/2017 Date Work Ended 6/29/2017 Latitude N Lon itude I W Local Permit Agency San Joaquin County Environmental Health DeDartment iI 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 TaVlor Fertilizer c/o Eric Jenks Drilling Method Sonic Drilling Fluid None Mailing Address PO Box 511 Depth from Surface Description Feet to Feet Describe material,grain size,color,etc City Yuba City State CA zip 95991 I 0 23 primaril clay and sandy clay with silt. Well Location 23 27 primarily sand with silt. Address 1819 S. Argonaut Street 27 33 primarily sand. City Stockton County San Joaquin 33 57 primarily clay. Latitude N Longitude W 57 60 pdmarily sandy clay. Deq. Min Sec. Dea Min Sec. 60 65 primarily clayey sand with silt. Datum NAD83 Dec.Lat. 37.93160160 Dec. Long.-121.304488,b 65 70 primarily clay. APN Book 163 Page 200 Parcel 08 70 75 primarily sand. 1 Township T1 N Range R6E Section S15 75 80 primarily sandy clay with silt. Location Sketch Activity $� 90 primarily Clay with silt. Sketch must be drawn byll hand after form is anted. Q New Well Q Modification/Repair Q Deepen O Other p Destroy Describe procedures and materials under'GEOLOGIC LOG' Planned Uses Q Water Supply []Domestic ❑Public w ❑Irrigation ❑Industrial O Cathodic Protection O Dewatering O Heat Exchange G) Injection O Monitoring O Remediation O Sparging South O Test Well ulu:bate o describe distance of well from reads,br,iidinys,renoes. Q Vapor Extraction fivers,etc and attach a map.Use additional paper it necessary. Q Other Please be accurate and com fete. Water Level and Yield of Completed Well Depth to first water 20 (Feet below surface) Depth to Static Water Level (Feet) Date Measured 06/29/2017 Total Depth of Boring 90 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. Casin s Annular Material Depth from Borehole Type Material wall Outside Screen Slot Size Depth from Surface Marne'ter yP ifi-Kire55 Diarnieter Type if miry sm ace Fiii DeSGriptiurr Feet to Feet Inches Inches Inches Inches Feet to Feet 0 60 6 3/4 Blank PVC Sch.80 0.15 2 0 155 Cement type 2 portland 60 80 6 3/4 Screen 80 Stainless Steel 0.15 2 Wire Wrap 0.010 55 58 Bentonite hydrated 1/4"Chips 58 81 Filter Pack #2/12 sand 81 90 Bentonite hydrated 1/4"chips Attachments Certification Statement ❑� Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief ElWell Construction Diagram Name Gregg Drilling&Testinq Inc ❑ Geophysical LO S Person,Firm or Corporation Log(s) 950 Howe Rd Martinez CA 94553 ❑ Soil/Water Chemical Analyses Address City State zip El Other Site Plan Signed 4 G_ 10/17/2017 485165 Attach additional information if it exists. C-57 Li sed Water Well Contractor Date Signed C-57 License Number DWR 188 REV,1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM