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ON a'The'free Adobe Reader may be used to view and com is form. However, software must be purchased to oompiet and reuse a saved form. File Original with DWR State of California Page 1 of 1 Well Completion Report Refer to Instruction Pamphlet Owner's Well Number MW4A No. e0185551 Date Work Began 05/30/2013 Date Work Ended 5/31/2013 Local Permit Agency San Joaquin EHD Permit Number 67121 Permit Date 5/8/13 Orientation OVerticai 0Horizontal OAngle Specify Drilling Method Direct Rotay Drilling Fluid Bentonite mud Depth from Surface Feet to Feet Description Describe material grain size color, etc 0 5 Yellow Brown SiltV Sand 5 8 Gray Brown Sand 8 13 Gray Brown Silty Clay with Sand 13 18 Yellow Brown Sand 18 23 Yellow Brown Silt with Sand 23 28 Yellow Brown Silty Sand 28 38 Olive Brown Silt 38 43 Olive Brown Clay 43 53 Olive Brown Silt 53 58 Olive Brown Silty Clay 58 63 Olive Brown Clayey Silt 63 68 Yellow Brown Silty Sand 68 73 Olive Brown Silty Clay 73 83 Yellow Brown Sandy Silt 83 110 Brown Sand 110 121 Brown Sandy Gravel 121 148 Brown Silt 148 155 Brown Sand with Gravel Total Depth of Boring 155 Feet Total Depth of Completed Well 1551 Feet DWR Use Only Do Not Fill In L 11 State Well Number/Site Number �i INI 1.I I1 i 1i W Latitude Longitude APNrrRS/Other Name San Joaquin Public Works- Solid Waste Dovosion Mailing Address 1810 East Hazleton Ave City Stockton State CA 7iD 95207 Address 14750 East Harney Lane City Lodi County San Joaquin Latitude N .Longitude __yv Dea. Min. Sec. DOD. Min. Sec. Datum Dec. Lat. Dec. Long. APN Book 065 Page 030 Parcel 06 ( A 00 Illustrate or describe distance of well from roads, buildings, fences, rivers, etc. and attach a map. Use additional paper If necessary. U New Well O Modification/Repair O Deepen O Other O Destroy Describe nrooedures and matedals O Water Supply ❑Domestic ❑Public ❑ irrigation ❑ Industrial O Cathodic Protection O Dewatering O Heat Exchange O Injection O Monitoring O Remediation O Sparging O Test Well O Vapor Extraction O Other Depth to first water 138 (Feet below surface) Depth to Static Water Level (Feet) Date Measured 05/29/2013 Estimated Yield (GPM) Test Type Test Length (Hours) Total Drawdown (Feet) *Mav not he renresentative of a well's Innn farm viairi DWR 188 REV. 1/2006 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM Casings Annular Material Depth from Borehole Type Surface Diameter Feet to Feet Inches Material wall Outside Screen Thickness Diameter Type Inches Inches Slot Size if Any Inches Depth from Surface Fill Description Feet to Feet 0 135 110 Blank PVC Sch. 80 2.375 0 1120 Cement 135 155 110 Screen PVC Sch. 80 2.375 Milled Slots 0.020 120 130 Bentonite Pellets 0 135 10 Blank PVC Sch. 80 1.25 130 155 Filter Pack 2/12 135 155 10 Screen PVC Sch. 80 1.25 Milled Slots 0.020 Attachments Certification Statement ❑ Geologic Log ® Well Construction Diagram 0 Geophysical Log(s) ® Soil/Water Chemical Analyses ❑ Other Attach additional information if it exists. I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief Name _Gregg Drilling and Testing. Inc Person, Finn or Corporation 950 Howe Rd Martinez CA 94553 Add city stele Zip Signed ? ))-0 485165 C5 Icensed water well ctor Date Signed C-57 License Number DWR 188 REV. 1/2006 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM