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Owner's Well Number
Date Work Began M
Loral Permit Agency
Permit Number_
State of California
Well Completion Report
Refer to Instruction Pamphlet
No. XXXXXXX
Date Work Ended 2/10/2023
NVIROMENTAL HEALTH DEPARTMENT
Permit Date
Geologic Log Well Owner
Orientation OVertical O Horizontal OAngle speciry. Name Brendan Gill
Drilling Method Drilling Fluid
Depth from Surface Description Mailing Address 13056 Holler Ave
Feet to Feet Describe material, grain size, color, etc City CHICO State CA 7in 95973
0 1 CLAY Well Location
1 4 HARD PAN Address 13056 Hosler Ave
4 8 TAN CLAY City CHICO County Butte
8 15 CLAY AND ROCKS Latitude N Longitude _ �N
15 44 CLAY Dea. Min. Sec. De¢ Min. Sec.
44 57 LOOSE GRAVEL Datum Decimal Lat. Decimal Long.
57 71 HARD TAN CLAY APN Book 006 Page 660 Parcel 035
71 92 1 CEMENTED GRAVEL Township Rance �._- opotion �-
92 117 LIGHT RED CLAY Location Sketch 11 Activi
117 139 CEMENTED GRAVEL&ROCKS Sketch mull be arawnb hand after tone is rented. • New Well
North O Modih .Rtion/Repair
139 1177 HARD TAN CLAY 1.
177 1192 CEMENTED SAND AND GRAVEL I O Other
192 221 HARD TAN CLAY O Destroy
cescnne couedures am materials
221 1235 LOOSE GRAVEL urfer'GEGLGGICLGG°
235 242 clay PlannedUses
242 300 loose gravel I (E) Water Supply
!fEDDomestic ❑Public
m ❑Irdantion ❑Industrial
5
O Cathodic Protection
O Dewatering
O Heat Exchange
O Injection
0 Monitoring
O Remediation
O Sparging
Test Well
South O
inunrote ornesa,be distance or well from mars, ould"s, lances, O Vapor Extraction
rwers, ete, and abach a man. Use add ionai prier if neo dnan_ O Other.
Please be accurate and cam em.
Water Level and Yield of Completed Well
Depth to first water 44 (Feet below surface)
Depth to Static
Water Level 75 (Feet) Date Measured 02/10/2023
Total Depth of Boring 300 Feet Estimated Yield' 300 (GPM) Test Type Air Lift
Total Depth of Completed Well 300 Feet Test Length 0.3 (Hours) Total Drawdown 0 (Feet)
*May not be representative of a well's long term yield.
Casings Annular Material
Depth from Borehole Type Material wall Outside Screen Slot Size Depth from
Surface Diameter yP Thickness Diameter Type if Any Surface Fill Description
Fact to Feet Inches Inches Inches Inches Feet to Feet
0 240 10 Blank PVC Sch.40 5 0 125 1 Bentonite SLURRY MIX
250 300 10 Screen PVC Sch. 40 5 Milled Slots 0.032 25 300 Filter Pack 3/8 gravel
Attachments Certification Statement
❑ Geologic Log I, the undersigned, certify that this report is Complete and accurate to the best of my knowledge and belief
❑ Well Construction Diagram Name TIM BESSEor WELL DRILLING
❑ Geophysical Log(s) 4550 BESSEPersonR�COURlm or Tmtron CHICO CA 95973
❑ SoillWater Chemical Analyses // �Aaares6 City State zip
El Other Signed �/�/y� 46""-4t, 2/10/2023 598765
Attach additional intonnation 6 it exists. C-57 Licensed Water Well Contractor Date Si ned C-57 License Number
DWR 188 REV. 1/2006 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM