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The free Adobe Reader may be used to view and compIc form. However,software must be purchased to complete,Alft and reuse a saved form. <br /> File Original with DWR State of California DWR Use Only—Do Not Fill In <br /> Page 1 of Well Completion Report <br /> Refer to Instruction Pamphlet State Well Number/Site Number <br /> Owner's Well Number EW-B No. e0354610 <br /> N W <br /> Date Work Began 06/22/2017 Date Work Ended 6/23/2017 Latitude Longitude <br /> Local Permit Agency San Joaquin County Environmental Health Department <br /> Permit Number SR0077771 Permit Date 6/19/17 APNfTRS/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical 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 23 primarily clay and clay with sand. Well Location <br /> 23 30 primarily sand. Address 1819 S.Argonaut Street <br /> 30 63 primarily clay with sand and clay. City Stockton County San Joaquin <br /> 63 70 primarily sand. Latitude N Longitude W <br /> 70 80 primarily Clay. Dea. Min. Sec. Deo. Min Sec. <br /> 80 82 silty sand seam. Datum NAD83 Dec.Lat. 37.93197980 Dec.Long.-121.303459% <br /> 82 83 primarily clay. APN Book 163 Page 200 Parcel 08 <br /> Townshi 11 N Ran e R6E Section S15 <br /> Location Sketch Activ' <br /> Sketch must be drawn by hand after form is printed. Qi New Well <br /> North <br /> Q Modification/Repair <br /> O Deepen <br /> O Other <br /> Q Destroy <br /> Desmibe procedures and materials <br /> under'GEOLOGIC LOG' <br /> Planned Uses <br /> Q Water Supply <br /> []Domestic ❑Public <br /> M ❑Irrigation ❑Industrial <br /> w <br /> Q Cathodic Protection <br /> Q Dewatering <br /> Q Heat Exchange <br /> Q Injection <br /> Q Monitoring <br /> Remediation <br /> Q Sparging <br /> South Q Test Well <br /> nwsbate«aesabe dill—,o—11 from road:,buildings,fenc Q Vapor Extraction <br /> rivers,etc,and attach a map.Use additional paper if necess_ p Other <br /> Phase be accurate and com fete. <br /> Water Level and Yield of Completed Well <br /> Depth to first water 23 (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured 06/23/2017 <br /> Total Depth of Boring 86 Feet Estimated Yield* (GPM) Test Type <br /> Test Length (Hours) Total Drawdown (Feet) <br /> Total Depth of Completed Well 85 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 /> Surfs Diameter�. Type Material Th,^� C;^... Type f ;y <br /> DeaCri NiiGi i <br /> Feet to FeetInches Inches' Inches Inches Feet '. Feet <br /> 0 63 8 3/4 Blank PVC Sch.80 0.24 4 10 57 Cement type 2 portland <br /> 63 85 8 3/4 Screen 80 Stainless Steel 0.24 4 Wire Wrap 0.010 57 60 Bentonite hydrated 1/4"chips <br /> 60 86 Filter Pack #2/12 sand <br /> Attachments Certification Statement <br /> El Geologic Log I,the undersigned,certi that this report is complete and accurate to the best of my knowledge and belief <br /> ❑� Well Construction Diagram Name Gregg Dril t�ling Testing, Inc <br /> El Geophysical Log(s) 950 Hower Rd Firm or Corporation Martinez CA 90755 <br /> ❑ Soil/Water Chemical Analyses Address r_ City State zip <br /> ❑� Other Site Plan Signed / � 10/17/2017 485165 <br /> Attach additional information if it exists. C-57 Li4seerWater 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 />