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'The free Adobe Reader may be used to view and complete this form. However,software must be purchased to complete,save,and reuse a saved form. <br /> File Original with DWR State of Cailfamia DWR Use Only—Do Not Fill In <br /> Page 1 of 1 Well Completion Report <br /> Rotor to lastrudlon Pamphlet State Well Number/Site Number <br /> Owner's Well Number No.0351936 NI I I I I T7w1 <br /> Date Work Began 07/13/2017 Date Work Ended 9/6/2017 Latitude Longitude <br /> Local Permit Agency San Jaoeuin County Environmental Health Dept. <br /> Permit Number SR0077815 Permit Date 6/23117 APWTRS10ther <br /> 1 Geologic Log Well Owner <br /> orlentation OVertical O Horizontal OAngle Speaty Name Chinchiolo Stemilt Packing Wo Tod <br /> Dri1ing Method Reverse Rota Drilling Fluid Water <br /> Mailing Address 4799 N Jack Tone Rd <br /> Depth from Surface Description <br /> Feet In Feet Describe material rein size color,etc City Stockton State CA 71p 95215 <br /> 0 6 Clay Well Location <br /> 6 20 Sand and Gravel Address 4887 N Jack Tone Rd <br /> 20 45 Clay City Stockton County San Joaquin <br /> 45 90 Sand and gravel Latitude N Longitude �ro <br /> 90 100 Clay Dea. Min. sec. Deo. Mn. Sec <br /> 100 108 Sand Datum Dec.Lat. Dec.Long, <br /> 108 130 Clay APN Book 089 Page 170 Parcel 59 <br /> 130 142 Sand Township -Range Section <br /> 142 150 Clay Location Sketch Activity <br /> 150 160 Sand sketch must be drawn b hand efterfomt Is nted. Q New,Well <br /> North Q Modficationt/Repair <br /> 160 190 clay Q Deepen <br /> 190 210 Sand O Other <br /> 210 305 clay Q Dtf�Oytx000dures eM metMa e <br /> 305 314 Black Sand "de` 0LO01C1°` <br /> 314 j 360 Clay Planned Uses <br /> 360 400 Sand Q Water Supply <br /> 400 428 Clay ❑Domestic ❑Public <br /> 428 444 Sand&gravel ❑Irrigation ❑Industrial <br /> 444 500 Clay Q Cathodic Protection <br /> Q Dewatering <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remedlatlon <br /> O Sparging <br /> South O Test Well <br /> Uuurete brdosatba datenca otaea tram roads,burdno4 tenua, O Vapor Extraction <br /> Mhya,du end Bloch a=P.the addtou� � <br /> hrn %• Q Other <br /> Ptea.e m ooaeam end ata <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level 152 (Feet) Date Measured <br /> Total Depth of Boring 500 Feet Estimated Yield' 1,574 (GPM) Test Type <br /> Total Depth of Completed Well 450 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 BoreholeT e Material Wall Cutsido Screen Slot Size Depth from <br /> Surface Diameter Type Thickness Diameter Type If Any Surface FIII Description <br /> Feet to Fee! Inches Inches Inches Inches Feet to Feat <br /> 0 100 36 Conductor Mild Steel .25 30 0 100 Cement 10.3 sack <br /> 0 360 26 Blank Mild Steel .25 16 450 Filter pack No.6 sand pack <br /> 360 450 26 Ful-Flow Mttd Steel .25 16 0.090 <br /> Attachments Certification Statement <br /> ❑ Geologlc Log I,the undersigned,certify that this report Is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name nnin s Br DriliinCo., Inc. <br /> Q Person,Firm <br /> or Co pora on <br /> Geophysical Log(s) 1930 Ladd Rd <br /> Modesto CA 95356 <br /> ❑ SolYWater Chemical Analyses <br /> dd ty Slate 71p <br /> ❑Other Signed 09-08-17 290813 <br /> Aaarh additional information c it wrists, C-57r kensed waterweu Contractor Date Signed C-57 License Number <br /> DWR 180 REV.112006 IF ADDITIONAL SPACE IS NEEDED.USE NEXT CONSECUTIVELY NUMBERED FORM <br /> J <br />