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'The free Adobe Reader may be used to view and complete_this form. However, software must be purchased to complete, s=t,n. and reuse a saved form <br />°Angle Specify <br />Drilling Fluid <br />Geologic Log <br />Orientation ®Vertical 0 Horizontal <br />Drilling Method Sonic <br />Description <br />Describe material, grain size, color, etc <br />See attached boring log <br />Depth from Surface <br />Feet to Feet <br />135 Feet Total Dep h of Boring <br />Total Depth of Completed Well 125 Feet <br />Casings <br />0 New Well <br />Modification/Repair <br />0 Deepen <br />0 Other <br />(;) Destroy <br />Describe procedures and materials <br />under "GEOLOGIC LOG" <br />Activity Location Sketch <br />(Sketch must be drawn by hand after form is printed.) <br />North <br />Church <br />Street <br />Screen <br />Type Type Fill Material Slot Size <br />if Any <br />(Inches) <br />Borehole <br />Diameter <br />(Inches) <br />Description <br />Depth from <br />Surface <br />Feet to Feet <br />Depth from <br />Surface <br />Feet o Feet <br />Wall Outside <br />Thickness Diameter <br />(Inches) (Inches) <br />ate Signed C-57 License Number <br />I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief <br />Name Applied Water Resources <br />Person, Firm or Corporation <br />2363 Mariner Square Drive Ste 245 Alameda <br /> <br />CA 94501 <br />dd City State Zip <br />-57 Lic6 aaell Contractor <br /> 983523 <br />File Original with DWR <br />Page 1 of 1 <br />Owner's Well Number EW-7 <br />Date Work Began 04/06/2016 <br />DWR Use Onl — Do Not Fill In <br />t 1 1 I I I <br />State Well Number/Site Number <br />1 1 1 fsil 1 1 1 1 fir! <br />Latitude Longitude <br />1 1 t 1 I I I I I I I <br />APN/TRS/Other <br />State of California <br />Well Completion Report <br />Refer to Instruction Pamphlet <br />No. e0320421 <br />Date Work Ended 4/11/2016 <br />Well Owner <br />Name City of Lodi <br />Mailing Address 221 West Pine Street PO Box 3006 <br />City Lodi State CA 7jp 95241 <br />Well Location <br />Address Church and Tokav Street <br />San Joaquin <br />de <br />City <br />yituLodi N Longitude <br /> County <br />Min. Sec. <br />Dec. Lat. 38.126608 Dec. Long. -121.275924 <br /> Page Parcel <br /> Range Section <br />Depth to first water (Feet below surface) <br />Depth to Static <br />Water Level (Feet) Date Measured <br />Estimated Yield * (GPM) Test Type <br />Test Length (Hours) Total Drawdown (Feet) <br />*May not be representative of a well's long term yield. <br />Annular Material <br />Deo. Min. Sec. <br />Attachments <br />Geologic Log <br />0 Well Construction Diagram <br />Geophysical Log(s) <br />Soil/Water Chemical Analyses <br />0 Other <br />Attach additional information, If it exists. <br />DWR 188 REV 1/2006 <br />Certification Statement <br />IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />Signed <br />Local Permit Agency San Joaauin Countv-EHD <br />Permit Number SR0074595 Permit Date 3/31/16 <br />Cement 73 0 6 PVC Sch. 80 <br />75 Milled Slots 73 6 0.040 3/16 Copperbearingsteel <br />135 PVC Sch. 80 75 6 <br />0 80 12 Blank <br />80 120 12 Screen <br />120 125 12 Blank <br />Bentonite <br />Filter Pack <br />RECEIVED <br />AUG 25 2016 <br />ENVIRONMENTAL HEALTH <br />PEFtMITISERVICES <br />Ded <br />Datum NAD83 <br />APN Book <br />Township