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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. FI V Onginal with DWR State of Califomia Page 1 of 1 Well Completion Report Refer to Instruction Pamphlet Owner's Well Number #1 No. e0355064 Date Work Began 10/16/2017 Date Work Ended 10/18/2017 Local Permit Agency SAN 2A _,QIJJN_Q=qTyEWIRONMENTAL HEALTH DEPT Permit Number WP0037333 _ Permit Date 9/13/17 Orientation OVertical O Horizontal OAngle Specify Drilling Method Drilling Fluid Depth from Surface Description Feet to Feet _ Describe material, grain size color, etc 0 2 OVERBURDEN 2 180 SANDSTONE 180 260 SANDSTONE AND BREAKS 260 340 SANDSTONE AND SAND WATER BEARING Total Depth of Boring 340 Feet Total Depth of Completed Well 340 Feet DWR Use Only – Do Not Fill In j State Wall Numbern5lte Number T L—L_�– ] Ier—I=I=T I W r Latitude LoLon itude APN/TRS/Other I Owner Name JOE SCHENONE: Mailing Address 5256 NORTH CONFER ROAD City STOCKTON _ State C_Zip 95215 Well Location Address 27251 EAST_I- ARNEY LANE City LODI --County San Joaquin Latitude 38 7 21 N Longitude 120 58 5_y� Deo. Min, Sec. Deq. Min. Sec. Datum Decimal Lat. Decimal Long. APN Book 067 Page 210 __• Parcel 01 Township T3N Range 9E___ Section 10 Location Sketch Activitv Sketch must be drawn by hand after form isriited. O. New Well O Modification/Repair North / 2 G So►t► O Deepen by04!:oW7,,l/ O Other O Destroy Describe procedures and materiels Test Length 4.0 under "GEOLOGIC LOG* Planned Uses G/� O Water Supply \ r� \ G/�r� N ❑ Domestic ❑ Public 3a ❑Irrigation ❑Industrial \ O Cathodic Protection B O Dewatering (y 2� / /tit/S O Heat Exchange / 1O O Injection lo Monitoring STEEL 0.188 6,625 Milled Slots O Remediation w�GG� L O Sparging South O Test Well O Vapor Extraction tllusbets or describe distance of well from reeds, buildings, fences, rivers, etc. and aItachamap. Use eddidonel paper lfneceeeary. Please be accurate and wmolets. O Other AGRICULTURAL (Nater Level and Yield of Completed Well Depth to first water 2,1� _ (Feet below surface) Depth to Static Material Wall Outside Screen Water Level 210 _(Feet) Date Measured 10/18/2017 Estimated Yield ' 45 _(GPM) —__ Test Type Constant Rate Test Length 4.0 (Hours) Total Drawdown (Feet) 'May not be representative of a well's Iona term vield. Casings Annular Material Depth from Borehole Type Material Wall Outside Screen slot Size DU th from P Surface Feet Diameter Thickness Diameter Type if Any Surface Fill Description to Feet Inches Inches Inches Inches Feet to Feet 055 Cement PUMPED IN 0 240 8.625 BLANK STEEL 0.156 6.625 240 340 8,625 screen STEEL 0.188 6,625 Milled Slots 0.060 I—q — LJ Geologic Log ❑ Well Construction Diagram ❑ Geophysical Log(s) ❑ Soil/Water Chemical Analyses ❑ Other DWR 188 REV. 1/2006 Certification Statement I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief Name BRISKI WELL DRILLING CO INC Person, Firm or Corporation 2918 HWY 12 SAN ANDREAS CA 95249 Address City State Zip Signed _ 10/18/2017 #237647 C-57 Licensed Water Well Contractor Date Signed C-57 License Number IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM