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TRIPLICATE <br /> STATE OF CALIFORNIADWR ONLY — 00 NOT FILL IN <br /> Owner's Copy WELL COMPLETION REPORT III III <br /> Psge I of t Refer to Instruction Pamphlet STATE WELLNO.1 STATION NO. <br /> Owner's Well No. 95227 No. EI ❑ <br /> Date Work Began 21112018 Ended LATITUDE LONGITUDE <br /> Local Permit Agency EnVios7mental Haskffh I I I I I I I I I I I I I <br /> Permit No. 7793 Pmt Date 1/122018 APNMMOTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(2) VERTICAL —HORIZONTAL —ANGLE —(sPEcim Name Karen Berg <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID MUD Mailing Address P.O. BOX 325 <br /> SURFACE DESCREMON Clements CA 95227 <br /> FL Ic FL Describe material, grata, size, color, etc. CITY STATE ZIP <br /> 0 3 12p Soil Address 26192 N MaekWrle Ftd LOCATION <br /> 3 5 ClayClerneCA 95227 <br /> 5 7 Sand City <br /> Ms <br /> 7 11 SCounty$an�tMuin <br /> APN Hook Page Parcel <br /> 11 301 Sand Township Range Section <br /> 30 38 1 Clay <br /> Latitude I i , <br /> 38 40 Gravel DEG. MIN. SEC. DEG. MIN. SEC. <br /> 40 59 Clay LOCATION SKETCH ACTPATY LI) <br /> 59 64 Sand NOmH -SL NEW WELL <br /> 64 90 Clay <br /> MODIFICATIONAZWPAIR <br /> —Dow- <br /> 90 104 Shale --OIJ—(SP-1y) <br /> 104 1201 Sand <br /> DESTROY(Daatae <br /> 120 138 l,o.a,n.anSteele Pd rt.ewlw <br /> 138 148 Sand UnAw'GEOLOGIC L <br /> PLANNED USES(4) <br /> 146 150 Shale WATER SUPPLY <br /> 150 181 Brach Sand Dwww— Prex <br /> 181 187 Shale Irrjgswrl — � <br /> 187 237 Blade Sand and Gravel MONITORING— <br /> TEST wELL- <br /> 237 244 Shale <br /> THOWC PROTECTION_ <br /> 244 258 Gravel HEAT EXCHANGE— <br /> 258 260 Black Sand DIRECT PUSH_ <br /> 260 270 Gravel INJECTION— <br /> 270 278 Black Sand VAPOR EXTRACTION— <br /> SPARGING_ <br /> 276 285 Gravel SOUTH REMEDIATION— <br /> RlrenvM or D—ibe Di ft—eW fi fiver Raod+. Erik wla. <br /> 285 2961 Black Sand Fmos.Rivrk arc and s twl.m�p� Un hdAitim�Ipeper a OTTER(SPECIFY)_. <br /> 296 300 Shale •eewmM. �AS9 ae ACCURATE • coM7LCIL <br /> 300 330 Blade Sand WATER LEVEL&YIELD OF COMPLETED WELL <br /> 330 343 Shale DEPTH TO FIRST WATER- (Ft)BELOW SURFACE <br /> 343 350 Black Sand DEPTH OF STATIC <br /> 350 3537 Shale WATER LEVEL (FL)6 DATE MEASURED <br /> ESTIMATED YIELD ' (GPM)d TEST TYPE <br /> TOTAL DEPTH OF BORAiG 500 (Fed) TEST LENGTH <br /> —("m.) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPL.ET M WELL (Foot) Mav not be repmewxive of a well' Torr Perm yield <br /> DEPTH CASING(S) _ DEPTH ANNIfI.AR MATERIAL <br /> FROM SURFACE HOLE TYPE FROM SURFACE <br /> DIA. W MATERIAL 1 INTERNAL GAUGE SLOT SIZE �_ g£ <br /> Oma) GRADE DIAMETER OR WALL IF ANY MENT TON FILL FILTER PACK <br /> Ft. to FL rn U W (Irt<lw) THICKNESS (1114 FL b Ft (IYPEJSIZE) <br /> (�) U <br /> ATCACHMiN" CERTIFICATION STATEMENT <br /> G-bW Log 1.trA wtwoa+b,ew"tfrt eft mport is=%"wW wo"Is to to bat of my Wwwledge nA boW. <br /> — wa Cordbiclon DAgw. NAME MASELLIS DRILLING INC <br /> GaWMSkM LMS) (PERSON,F OR CORPORATION) (TYPED OR PRINTED) <br /> SoWlkbr ChwrkW An*pk -12 bq* Modesto 95357 <br /> ADDRESS CITY STATE ZIP <br /> Dow <br /> ATTACH ADDMONAL AFORK0"V.IF IT E)GSTS 05/07/18 668822 <br /> �� WELL RE 8ENTA OATS SIGNED "7 LICENSE NUMBER <br /> DWR IN RFV.11-97 IF ADDITIONAL SPACE IS NE D,USE NEXT CONSECI"IVELY N10MBERED FORM <br />