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*The free Adobe Reader may be used to view and compl is form. However,software must be purchased to complete,: and reuse a saved form. <br /> File Original with DWR State of California - 'DWR Use Onl'-Do Not Fill In " <br /> Well Completion Report <br /> Page 1 of 1 Rererro interaction Pamphlet State Well Number/Site Numb. _. er <br /> Owner's Well Number GW-20 No. 00196069 W <br /> Date Work Began 11/06/2013 Date Work Ended 11/6/2013 LamweLo rude <br /> Local Permit Agency `an oacum Environmental Health Deoartment <br /> APN?RS/Omer <br /> Permit Number Permit Date 10/11/13 <br /> Geologic Log Well Owner <br /> Orientation OVertical O Horizontal OAngle Speofv Name Sutter Home Winery <br /> Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address PO Box 249 <br /> Depth from Surface Description St Helena State CA �I 94574 <br /> Feet to Feet Describe material, min size,color,etc Cit <br /> 0 4 <br /> Sandy Silt Well Location <br /> 4 6 Silty Sand Address 18667 Jacob Brack Rd <br /> 6 7 Poorly Graded Sand City Lodi County San Joaquin <br /> 6.5 8 Silty Sand Latitude N Longitude __JN <br /> 8 10 Poorly Graded Sand Dan_ Min. Sec. Dea. Min. Sec <br /> 10 12 Sandy Silt Datum Dec.Lat. Dec.Long. <br /> 11.5 15 Sandy Silt to Silty APN Book Page Parcel 011-090-04 <br /> Township —Range Section <br /> Location Sketch Activity <br /> Sketch must be tlIs.by hand after font,is nntea.'' Q New Weil <br /> North O Modification/Repair <br /> O Deepen <br /> O Other <br /> O Destroy <br /> onnsa Frouaur....d m.r.d.i. <br /> under'GEOLOGIO LOG' <br /> Ow .. O Water Supply❑ <br /> ❑Domestic Public <br /> 3 w []Irrigation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> Ori Monitoring <br /> O Remediation <br /> O Spangling <br /> South O Test Well <br /> inu.ane o.do.moo dm=�«or.,n rcom�o.e..omiemor.- O Vapor Extraction <br /> _ me nc.ens am.nemar,.uca eddmonei v, it�CCeSJery O Other <br /> ififeefwa-.rvis..d <br /> e. `letdRe . nell <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 15 Feet Estimated Yield (GPM) Test Type <br /> Total Depth of Completed Well 14.5 Peet Test Length (Hours) Total Drawdown (Feet) <br /> *May not be re resentatfve of a well's lonq term yield. <br /> Casings a Arinuf'ar`Material <br /> Depth from Borehole Wall Outside Screen Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Inches Inches Inches Inches Feet to Feet <br /> 0 5 9" Blank PVC Sch.40 1 1 0 3 Ce ant Neat Cement <br /> 5Screen PVC Sch.40 Milled Slots 0.010 3 4 Bentonite Chips <br /> 4 15 Fill 2/12 Sand <br /> 15 9" <br /> Attachments Ceirlieat�on?9'a em`eriF <br /> ❑� Geologic Log I,the undersigned,carryry that this report is complete and accurate to the best of my knowledge and belief <br /> 0 Well Construction Diagram Name Woodward Drillina Comoanv. Inc. <br /> Person,Firm or Corporetbn <br /> ❑ Geophysical Log(s) 550 River Voted Rio Vista CA 94571 <br /> ❑ SoilAMater Chemical Analyses Address C14 <br /> city state zip <br /> 13 Other Signed /2/2013 710079 <br /> AGecle additional Information if It swats. cs71­00nsedwaren (contractor Date Signed C-57 License Number <br /> MR 188 REV,12006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />