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The free Adobe Reader may be used to view and complet form. However,software must be purchased to complete,r 1nd 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 EW-A NO. e0354609 N W <br /> Date Work Began 06/27/2017 Date Work Ended 6/28/2017 Latitude Longitude <br /> Local Permit Agency San Joaquin County Environmental Health Department �1 <br /> Permit Number SR0077771 Permit Date 6/19/17 APN/TRS/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 7i 95991 <br /> 0 25 primahly clay and sandy clay. Well Location <br /> 25 32 primarily sand. Address 1819 S.Argonaut Street <br /> 32 70 primarily clay with sand and sandy clay. City Stockton County San Joaquin <br /> 70 71 sand seam. Latitude N Longitude W <br /> 71 85 primarily clay with sand. Deq Min, Sea Deq Min Sec. <br /> Datum NAD83 Dec. Lat. 37.93151510 Dec. Long.-121.303135�6 <br /> APN Book 163 Page 200 Parcel 08 <br /> Townshi T1 N Ran a R6E Section S15 <br /> Location Sketch Activity <br /> Sketch must be drawn by hand after form is printed. ( New Well <br /> North <br /> Q Modification/Repair <br /> O Deepen <br /> 0 Other <br /> Q Destroy <br /> Desuibe procedures and materials <br /> under'GEOLOGIC LOG' <br /> Planned Uses <br /> Q Water Supply <br /> ❑Domestic []Public <br /> w ❑Irrigation ❑Industrial <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 /> Illustrate or describe distance of well from roads,buildings,fences, Q vapor Extraction <br /> rivers,etc.and attach a map.Use additional paper if necessary. Q Other <br /> Please be accurate and c—lete. <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 06/29/2017 <br /> Total Depth of Boring 85 Feet Estimated Yield" (GPM) Test Type <br /> Total Depth of Completed Well 80 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 fs Diameter Type Material ( ck ne- D°a;Teter Type oy SLi-f- e Fill Descrlptioli <br /> et Fe to Feet Inches inches Inches Inches Feet rto Feet <br /> 0 60 8 3/4 Blank PVC Sch.80 0.24 4 0 55 Cement type 2 portland <br /> 60 80 8/34 Screen 80 Stainless Steel 0.24 4 Wire Wrap 0.010 55 58 Bentonite hydrated 1/4"chips <br /> 58 85 Filter Pack #2/12 sand <br /> Attachments Certification Statement <br /> 0 Geologic Log I,the undersigned,certi that this report is complete and accurate to the best of my knowledge and belief <br /> 0 Well Construction Diagram Name Gregg Drilling I Testing, Inc <br /> ElGeophysical LO Person,Firm or Corporation <br /> g(S) 950 Howe Rd Martinez CA 94553 <br /> ❑ SoiVWater Chemical Analyses -Address, City State zip <br /> 0 Other Site Plan Signed G 10/17/2017 485165 <br /> Attach additional information if it exists. C57 Licensed ate(Well Contractor Date Si ied C-57 License Number <br /> DWR 188 REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />