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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL I <br /> For Local Requirements WELL COMPLETION REPORT1. <br /> Page 1 of 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95320 No-e0363999 <br /> Date Work Began 2/1/2018 Ended2/2/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Envirment Ir HP_ Ith . <br /> Permit No. wp0037874 Permit Date 1/29/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL _HORIZONTAL —ANGLE —(SPECIFY) Name Pam Dyer _ <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID MVD Mailing Address 16333 Lawrence Rd <br /> DESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 16333 Lawrencev% LOCATION <br /> 3 7 Hard Pan City Escalon CA 95320 <br /> 7 16 Clay CountySan Joaquin <br /> 16 18 1 Sand APN Book Page Parcel <br /> 18 24 Clay Township Range Section <br /> 24 38 Sand Latitude I 1 1 <br /> 38 42 Clay DEG. MIN, SEC. DEG. MIN. SEC. <br /> 42 46 Sand and Gravel LOCATION SKETCH ACTIVITY ) <br /> 46 83 Clay <br /> NORTH V NEW WELL <br /> 83 94 Sand MODIFICATION/REPAIR <br /> —Deepen <br /> 94 133 Clay —Other(Specify) <br /> 133 137 Sand <br /> — <br /> DESTROY (Describe <br /> 137 154 Clay Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> 154 158 Sand PLANNED USES() <br /> 158 183 Clay WATER SUPPLY <br /> 183 190 Sand C/) ; —1ZDomestic— Public <br /> 190 212 Clay — Irrigation — Industrial <br /> 212 214 Sand MONITORING— <br /> TEST WELL <br /> 214 223 Clay ATHODIC PROTECTION- <br /> 223 224 Sand HEAT EXCHANGE- <br /> 224 248 Clay DIRECT PUSH_ <br /> 248 251 Sand INJECTION— <br /> VAPOR EXTRACTION— <br /> 251 265 Clay SPARGING_ <br /> 265 283 Sand SOUTH REMEDIATION_ <br /> Illustrate or Describe Distance of Weft from Roads, Buildings, <br /> 283 317 Clay Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY) <br /> 317 319 Sand necessary- PLEASE BE ACCURATE & COMPLETE. <br /> 319 325 Clay WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STA C <br /> WATER LEVEL 2 (FL)&DATE MEASURED 2/2/2018 <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 325 (Feet) TEST LENGTH (His.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 285 (Feet) May not be representative o a well's long-term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE TYpE <br /> HOLE FROM SURFACE TYPE <br /> DIA. x P a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) xw p J GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> FL to Ft in w v LL (Inches) THICKNESS (Inches) Ft. to Ft ✓ (✓, �) (TYPEISIZE) <br /> 0 245 12 PLASTIC 6 201711 0 206 <br /> 245 285 ✓ GRAVEL <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 CORPORATION) (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 AlbersRd Modesto CA 95357 <br /> — Other ADDRESS ``r CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 03/01/18 668622 <br /> WELL DRILLER/AUT HO _ t5 REPR ENTATI DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 198 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />