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The free Adobe Reader may be used to view and comple 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 Owner's Well Number IW- State Well Number/Site Number <br /> B No. e0354611 N W <br /> Date Work Began 06l26/2017 Date Work Ended 6/29/2017 Latitude Longitude <br /> Local Permit Agency San Joaguin County Environmental Health Department <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 TaVlor Fertilizer c/o Eric Jenks <br /> Drilling Method Sonic Drilling Fluid None <br /> Mailing Address PO Box 511 <br /> Depth from Surface Description Yuba City CA 95991 <br /> Feet to Feet Describe material, rain size,color,etc CityState 7i <br /> 0 23 primarily clay and sandy clay with silt. Well Location <br /> 23 26 primarily sand. Address 1819 S. Argonaut Street <br /> 26 50 primarily clay with silt. City Stockton County San Joaquin <br /> 50 53 primarily sand. Latitude N Longitude W <br /> 53 90 primarily clay with sand. Deo. Min sec. Dea. Min sec. <br /> Datum NAD83 Dec. Lat. 37.93102480 Dec.Long.-121.3046958 <br /> APN Book 163 Page 200 Parcel 08 <br /> Townshi T1 N Ran e R6E Section S15 <br /> Location Sketch Activ' <br /> Sketch must be drawn by hand after form isprinted.) Oi 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 /> 55 <br /> w El Irrigation El Industrial <br /> 0 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 /> Illustrate or describe distance of well from roads,b"aainys,rend O Vapor Extraction <br /> fivers,etc.and attach a map.Use additional paper if necessar, 0 Other <br /> Pl_be accurate and complete. <br /> Water Level and Yield of Completed Well <br /> Depth to first water 20 (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured 06/29/2017 <br /> Total Depth of Boring 90 Feet Estimated Yield* (GPM) Test Type <br /> Test Length (Hours) Total Drawdown (Feet) <br /> Total Depth of Completed Well 80 Feet 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 /> face pia^eter Type Material Thic ____ --Teter Type sty Suiace Fill Description <br /> Feet"to Feet Inches Inches (Inches Inches Feet to Feet <br /> 0 60 6 3/4 Blank PVC Sch.80 0.15 2 0 60 Cement type 2 portland <br /> 60 80 6/34 Screen 80 Stainless Steel 0.15 2 Wire Wrap 0.020 60 63 Bentonite hydrated 1/4"chips <br /> 63 81 Filter Pack #2/12 sand <br /> 81 90 Bentonite hydrated 1/4"chips <br /> Attachments Certification Statement <br /> 0 Geologic Log I,the undersigned,certi�Y that this report is complete and accurate to the best of my knowledge and belief <br /> I] Well Construction Diagram Name Gregg Drilling tk Testing, Inc <br /> ❑ Geophysical LO Person,Firm or Corporation <br /> g(S) 950 Howe d Martinez CA 94553 <br /> ❑ Soil/Water Chemical Analyses Address city State zip <br /> ❑ Other Site Plan Signed � 485165 <br /> Attach additional information rf it exists. C-57 Liceed W ter Well Contractor D to SI ned C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPAC IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />