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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT ETI I ii I I 11 11 <br /> Page 1 of I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95337 NO.e0338063 �-- - <br /> Date Work Began 3/17/2017 Ended3/20/201.7 LATITUDE ❑ LONGITUDE <br /> Local Permit Agency Envlrcinmantal Health I I 1 1. 1 1 1 1 1 1 1 _L <br /> Permit No. 76921 Permit Date 3/8/2017 APWIRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Luis Brizuela <br /> DRILLING ROTARY DEPTH FROM METHOD FLUID Mud Mailing Address 5220 Almondwood Rd <br /> SURFACEDESCRIPTION Manteca CA 95337 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 2 Top Soil Address 5220 Almond wootl Rd LOCATION <br /> 2 14 Sand City Manteca CA 95337 <br /> 14 28 Clay <br /> 28 48 Sand County San Joaquin <br /> APN BookPage Parcel <br /> 48 64 Clay Township Range Section <br /> 64 69 Sand Latitude I I I <br /> 69 83 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 83 92 Sand LOCATION SKETCH ACTIVITY ) <br /> 92 134 Clay <br /> NORTH __v/_ NEW WELL <br /> 134 138 Sand MODIFICATION/REPAIR <br /> —Deepen <br /> 138 168 Clay —Other(Specify) <br /> 168 184 Sand <br /> DEOY 184 205 Clay —PProocedurres a0nd Materials <br /> Under"GEOLOGIC LOG' <br /> PLANNED USES() <br /> WATER SUPPLY <br /> Domestic— Public <br /> Q Irrigation _ Industrial <br /> tL MONITORING— <br /> TEST WELL <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH_ <br /> INJECTION— <br /> VAPOR EXTRACTION_ <br /> SPARGING_ <br /> SOUTH REMEDIATION— <br /> lllusfrare or Describe Distance of Well from Roads, Buildings, <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)_ <br /> necessary. PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STATIC <br /> WATER LEVEL 14 (Ft.)&DATE MEASURED 3/20/2017 <br /> TOTAL DEPTH OF BORING 205 ESTIMATED YIELD ' (GPM)8 TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WEU,185 (Feet) May not be representative of a well's long-term yield. <br /> DEPTHCASING(S) DEPTH ANNULAR ATERL <br /> FROM SURFACE BOE MIATYPE ✓) FROM SURFACE TYPE <br /> DIA. Y W a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. to Ft. <br /> (Inches) Z p a GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> m v LL (Inches) THICKNESS (Inches) Ft. to Ft ✓ 6L) U (TYPE/SIZE <br /> 0 165 12 <br /> 165 1851 v 1 1 .045 100 185 GRAVEL <br /> I <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 CORPORAT ) (TYPED PIR P INTfD) <br /> — Soil/Water Chemical Analysis 119 Albers •A Al 1 j Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. 11 Signed 03/22/17 668622 <br /> WELL DRILNOW11HOR JORESEKATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 F ADDITIONAL SPACE IS NEEDED,USE N=X1Wtv0NSE:CI FrivFiY NUMBERED FORM <br />