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-The free AdoberReader may be used to view and complf s form. However,software must be purchased to complete,s no reuse a saved form. <br /> File Original with DWR `"'� State of California DWR Use Only—Do Not Fin In <br /> Pae 1 of 1 Well Completion Report <br /> Page Refer to Instruction Pamphlet state Well NumbeMsite Number <br /> Owner's Well Number GW-22 No. e0196093 <br /> Date Work Began 11/06/2013 Date Work Ended 11/6/2013 Latitude Longitude <br /> Local Permit Agency San Joaquin Environmental Health Department <br /> Permit Number Permit Date 10/11/13 APN/TRs/Other <br /> Geologic Log Well Owner <br /> Orientation O Vertical O Horizontal OAngle SP"" Name Sutter Home Winery <br /> Drilling Method Hollow Stem Au er Drilling Fluid <br /> Depth from Surface .Description Mailing Address PO Box 249 <br /> Feet to Feet Describe material,grain size,color,etc City St Helena State_C_A__Z,p 94544 <br /> 0 3 Sandy Silt Well Location <br /> 3 8 Silty Sand Address 18667 Jacob Brack Rd <br /> 8 10 Silty Sand City Lodi County San Joaquin <br /> 10 12 Sandy Silt Latitude N Longitude _ _yv <br /> 11.5 14 Poorly Graded Sand Deo, Mln. Sec. Dep. Min. Sec <br /> 14 18 Sandy Silt Datum Dec. Lat. Dec. Long. <br /> 18 23 Silty Sand APN Book Paye Parcel 011-090-04 <br /> 23 28 Sandy Silt Township Range Section <br /> 28 30 Sandy Silt Location,Sketch Lo <br /> Activit <br /> 30 35 Sandy Silt (Sketch must be drawn by hand afterforn is printed) New Well <br /> North Modification/Repair <br /> 35 38 Silty Sand O Deepen <br /> 38 40 Poorly Graded Sand O Other <br /> 40 43 Sandy Clayey Silt Destroy <br /> o.er-G nOLOG're:a�a•r,.re,�ai. <br /> 43 45 Silty Sand �m«-cso�oc•.c Loc <br /> 45 48 Sandy Silt Planned Uses <br /> 48 50 Silty Sand N RECEIVED O Water Supply <br /> ❑Domestic [3 Public <br /> 3 ❑Irrigation ❑IntlusMal <br /> O Cathodic Protection <br /> JAN 1 4 201,, O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> ENVIRONMENTAL H- <br /> EAL OO Monitoring <br /> PERMIT/SERVI(:E O Remediation <br /> O Sparging <br /> South O Test Well <br /> wso-ete or a..r.diiiii iineli u ...a.. - nommen.bwO Vapor Extraction <br /> rd.um <br /> OOther <br /> rwaasaa..umamd ca w. <br /> 'n' -•10 -0:Corn leted Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 49.5 Feet Estimated Yield' (GPM) Test Type <br /> Total Depth of Completed Well Feet Test Length (Hours) Total Drawdown (Feet) <br /> *May not be representative of a well's long term yield. <br /> Casin s „, w '•" AnnuCar?Mateei'al, <br /> Depth from Borehole Type Material wall Outside Screen Slat Size Depth from <br /> Surface Diameter yp Thickness Diameter Type I/Any Surface Fill Description <br /> Feet to Feet (inches) Inches Inches Inches Feet to Feet <br /> 0 15 1 Bentonite Chips <br /> 5 50 Cement Neat Cement <br /> Attachments it <br /> ❑' Geologic Log I,the undersigned,certiffyy that this report is Complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name Woodward errillinD CO r Deny. Inc. <br /> Person,Flan«Cprptibibi <br /> 13 Geophysical Log(s) iv r Road Rio Vista CA 94571 <br /> ❑ Soil/1Nater Chemical Analyses Address -- city state zip <br /> ❑ Other Signed �i�p- i�lrrrili ri,,�Q 1/2/2013 710079 <br /> Attach additional lnformatwn.If it edsts. C-Sl Licensed er well armed Date Signed C-57 License Number <br /> DWR 18B REV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />