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,QUADRUPLICATE STATE OF CALIFORNIADWR USE ONLY — DO NOT FILL W <br /> For Local Requirements WELL COMPLETION REPORT I I I I I 1 i Ili I �- <br /> Page 1 of 2 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95227 NO.e0366510 I I I DF11 ❑ <br /> Date Work Began 5/4/2018 Ended5/8/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I 1 I 1 1 I I I I I I I I <br /> Permit No. wp0037793 Permit Date 1/12/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -�VERTICAL —HORIZONTAL — ANGLE —(SPECIFY) Name Biglieri Farms <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address P. O. BOX 604 <br /> SURFACE DESCRIPTION Clements CA 95227_ <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE zip <br /> 0 3 Top Soil Address 26192 N. Mackvte dLOCATIO <br /> 3 5 Clay City Clements CA 95227 <br /> 5 7 Sand County San Joaquin _ <br /> 7 11 Clay APN Book Page Parcel <br /> 11 30 Sand Township Range Section <br /> 30 38 Clay Latitude l 1 <br /> 38 40 Gravel DEG. MIN. SEC. DEG. MIN. SEC, <br /> 40 59 Clay LOCATION SKETCH ACTIVITY ) <br /> 59 64 Sand NORTH — --I/— NEW WELL <br /> MODIFICATION/REPAIR <br /> 64 90 Clay —Deepen <br /> 90 104 Shale —Other(Specify) <br /> 104 120 Sand <br /> 120 138 Shale — Procedures(Describe <br /> erials <br /> Under"GEOLOGIC LOG' <br /> 138 146 Sand PLANNED USES(+) <br /> 146 150 Shale WATER SUPPLY <br /> 150 181 Black Sand vii Domestic—Irrigation — Public rial <br /> 181 187 Shale � � <br /> 187 237 Black Sand and Garvel MONITORING— <br /> TEST WELL- <br /> 237 244 Shale ATHODIC PROTECTION_ <br /> 244 258 Gravel HEAT EXCHANGE- <br /> 258 260 Black Sand DIRECT PUSH_ <br /> 260 270 Gravel INJECTION— <br /> VAPOR EXTRACTION— <br /> 270 276 Black Sand SPARGING_ <br /> 276 285 Gravel SOUTH REMEDIATION_ <br /> Illustrate or Describe Distance of Well from Roads, Buildings, <br /> 285 296 Black Sand Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)- <br /> 296 300 Shale necessary. PLEASE BE ACCURATE & COMPLETE. <br /> 300 330 Black 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 /> 350 357 Shale WATER LEVEL 161 (Ft.)&DATE MEASURED 5/8/2018 <br /> TOTAL DEPTH OF BORING 500 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> —(Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL400 (Feet) Mav not be representative of a well's long-term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE �) FROM SURFACE TYPE _ <br /> DIA. Y w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) _ O GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft. to Ft. m o (inches) THICKNESS (Inches) Ft to Ft. ✓) (✓) �) (TYPE/SIZE) <br /> 0 300 20 V <br /> 300 400 50 400 GIMVEL <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 MASELL S DRILLING INC <br /> — Geophysical Log(s) (PERSON,F N ED) <br /> — Soil/Water Chemical Analysis 119 Albers Rd Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 06/04/18 668622 <br /> WELL DRILLER/A7" HOAR19'RrPR—E�:SWITATIVE' DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 189 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />