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DUPLICATE sTAT'E OF CALIFORNIA DWR USE ONLY 00 NOT Fl <br /> — <br /> Drilier's Copy WELL COMPLETION REPORT �ffi <br /> Page 1of 1 Refer to Instruction Yampblet STATE WELL NO.ISTATION NO. <br /> Owner's Well No. 1 No. 437540 1 1111 1 1 1 1 1 1E] <br /> Date Work Began07/22/96 <br /> . Ended 07/24/96 LATITUDE LONGITUDE <br /> Local Permit Apg <br /> Permit No. 11 Permit Date APN'TR <br /> i <br /> GEOLOGIC LOG .-W.,ELL OWNER <br /> ORIENTATION X VERTICAL HORIZONTAL ANGLE (SPECIFY) Name <br /> DEPTH TO FIRST WATER (FL)BELOW SURFACE ilin Address <br /> DEPTH FROM #, n C 4 �- A <br /> SURFACE: DESCRIPTION <br /> Ft. to Ft. Describe material,grain size,color,etc. ;' ` s STATE ZIP j <br /> �' OCATION <br /> 0 `Addcess`� 1W, r y <br /> 4 22 Sand -dit X Lan eca; <br /> 22 60 Clay -' '' k"COU.0y <br /> Sand <br /> a>.�► ma+4uin <br /> 60 65 C <br /> APN Book Page Parcel <br /> 65 98 ay <br /> ` '�� ToW nsltip Range Section <br /> 98 1110 n x; Latih]Cde' t NORTH Longitude WEST <br /> 110 i , Clay an -(EAS a DEO. MIN. SEC. DEG. AKIN. SEC. I <br /> ' LOCATION SKETCH CTIVITY (!) <br /> 115 122 : 5andy 5rwl@. NORTH NEW WELL <br /> 122 ; 123 Sa'n <br /> MODIFICATION/REPAIR <br /> 232 &: :��; <br /> i � .-[ _Deepen <br /> 142 : 14e $and ; _other(Specify) <br /> 148 r <br /> 153 . $5 .Gdls�r_96 5anid _oESTROY(oo:e,re. <br /> 155 1�58e+ ay ProceduresandAtalerdata <br /> Undee-GEOLOGIC LOO'7 <br /> 158 is9­:,ganoA- A- PLANNED USE(S)- <br /> go <br /> S�159 ; 1MONITORING <br /> 90 191 ; Sand WATER SUPPLY <br /> 191 : 220 : ay & Shale _ Domestic <br /> Public <br /> � � X artpatioa <br /> i Industrial <br /> i <br /> _ "TEST WELL" <br /> SOUTH -CATHODICTION PROTEC• ; <br /> Illustrate or Describe Distance of Well from Landmarks _OTHER(Specify) <br /> such as Roads,Buildings Fences,Rivers,etc. <br /> PLEASE BE ACCURA�'E&COMPLETE. <br /> DRILLING ROTARY FLUID WATER <br /> WATER LEVEL 6 YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC 19 <br /> WATER LEVEL (Ft.) & DATE MEASURED <br /> ESTIMATED YIELD (GPM) 3 TEST TYPE <br /> 220 <br /> TOTAL DEPTH OF BORING (ieej)2 TEST LENGTH (Hre.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 66 (Feet) 'May not be representative of a well's long-term yield. <br /> CASING(S) DEPTH ANNULAR MATERIAL <br /> DEPTH BORE- _ <br /> FROM SURFACE HOLE TYPE ✓ <br /> FROM SURFACE TYPE <br /> INTERNAL GAUGE SLOT SIZE _ <br /> DIA. W MATERIAL/ DIAMETER OR WALL IF ANY CE BEN- FILTER PACK <br /> (tnehea) s GRADE HENT TaNITE FILL <br /> Ft. to Ft. 1 0. (taches) THICKNESS (Inches) Ft. to Ft. (✓) (✓) (✓) (TYPE/SIZE) <br /> 0 102 10 1 1 PLASTIC 12 160 0 ; 50 X <br /> 101 111 1XI 1 1 .045 SO , 161 1 X1 GRAVEL <br /> 112 142 ' <br /> 142 162 X <br /> ATTACHMENTS (4) CERTIFICATION STATEMENT <br /> _ Geologic Los 1,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 /> (PERSON. FIRK OR CORPORATION)(TYPED OR PRINTED) <br /> Geophysical Log(s) <br /> Soa/Water Chemical Analyses 119 Albers Rd. Modesto CA 95357 <br /> CITY STATE lip <br /> _ Other <br /> ATTACH ADDiTIONAL INFORMATIOM IF tr EXISTS. signed 08/07/96 668b22 <br /> tNELI t AUT R NTATRE DATE SIGNED C-57 LICENSE It OMR <br /> DWR 188 REV.7-90 IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />