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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FIL IN <br /> For Local Requirements WELL COMPLETION REPORT I I I I I I I I I <br /> Page I of I Refer to Instruction Pamphlet STATE WELLNO./STATION NO. <br /> Owner's Well No. 95204 No.e0364005 <br /> Date Work Began 2/16/2018 Ended2/19/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I I I I I I I I I I i <br /> Permit No. wp0037791 Permit Date 1/12/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(.�L) -�/_VERTICAL —HORIZONTAL — ANGLE —(SPECIFY) Name Robert Oakes Tr. Etal <br /> DRILLING ROTARY Mailing Address P.O. BOX 4266 <br /> DEPTH FROM METHOD FLUID g <br /> SURFACEDESCRIPTION Stockton CA 95204 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top SoilAddress 29469 E.Vine RR�LL LOCATION <br /> 3 5 Hard Pan City Escalon CA 95320 <br /> 5 18 Sand CountySan Joaquin <br /> 18 43 Clay APN Book Page Parcel <br /> 43 46 Sand Township Range Section <br /> 46 80 Clay Latitude I I I <br /> 80 91 Sand and Gravel DEG. MIN. SEC. DEG. MIN. SEC. <br /> 91 125 Clay LOCATION SKETCH— ACTIVITY (✓) <br /> NORTH --V—" NEW WELL <br /> 125 129 Sand <br /> 129 160 Clay MODIFICATION/REPAIR <br /> 160 165 Sand —other(Specify) <br /> 165 1731 Clay <br /> DESTROY (Describe <br /> 173 175 Sand Procedures and Materials <br /> Under"GEOLOGIC LOG" <br /> 175 200 Clay PLANNED USESO <br /> 200 210 Sand WATER SUPPLY <br /> 210 216 Clay N Domestic_ Public <br /> Q �[ Irrigation _ Industrial <br /> 216 230 Sand LLJ <br /> 230 275 Clay MONITORING— <br /> TEST WELL- <br /> 275 279 Sand ATHODIC PROTECTION_ <br /> 279 283 Clay HEAT EXCHANGE- <br /> 283 290 Black Sand DIRECT PUSH— <br /> INJECTION— <br /> 290 313 Clay VAPOR EXTRACTION <br /> 313 320 Sand SPARGING_ <br /> 320 343 Clay SOUTH REMEDIATION <br /> — <br /> Blustrate or Desenbe Distance of Well from Roads, Buildings, <br /> 343 366 Clay Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)_ <br /> 366 368 Fine Sand necessary. PLEASE BE ACCURATE & COMPLETE. <br /> 3681 392 Clay WATER LEVEL&YIELD OF COMPLETED WELL <br /> 392 400 Coarse Black Sand DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> 400 450 Clay DEPTH OF STAT C <br /> WATER LEVEL 4 (Ft.)&DATE MEASURED 2/19/2018 <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 450 (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN <br /> (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL 406 (Feet) May not be representative o a well's lon -term yield <br /> DEPTH - CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE B ORE ffTY�PE ,:�) FROM SURFACE TYPE <br /> DIA• MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> Ft. to Ft. (Inches) THICKNESS (Inches) Ft. to Ft. (TYPE/SIZE) <br /> 0 206 21 vj PLASTIC 12 200 0 50 <br /> 206 246 .045 50 406 GRAVEL <br /> 246 266 <br /> 266 346 <br /> 346 386 <br /> 386 406 <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> — Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> — Well Construction Diagram NAME MASELLIS DRILLING INC <br /> — Geophysical Log(s) (PERSON,FIRM,OR CORPDRgTpol PPED OR I ED) <br /> — SoiUWater Chemical Analysis 11 Albers R " ° Y` tA. - Modesto CA 95357 <br /> — Other ADDRESS f ; �" I CITY STATE ZIP <br /> Signed 03/02/18 668622 <br /> ATTACH ADDITIONAL INFORMATION,IF ITIXISTS. WELL DRILLER/AUTHORIZEt REPRESENTATIVE DATE SIGNED C57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />