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QUADRUPLICATE STATE OF CALIFORNIA <br />For Local Requirements WELL COMPLETION REPORT <br />Page I of I Refer to Instruction Pamphlet <br />Owner's Well No. 95215 NO. e0348021 <br />Date Work Began 7/14/2017 Ended7/17/2017 <br />Local Permit Agency Environmental Health <br />Permit No. WP0036799 Permit Date 7/7/2017 <br />DWR USE ONLY — DO <br />NOT FILL IN <br />STATE WELL NO./ STATION NO. <br />LATITUDE LONGITUDE <br />APN/TRS/OTHER <br />ORIENTATION (2) <br />DEPTH FROM <br />SURFACEDESCRIPTION <br />Ft. to Ft. <br />GEOLOGIC LOG <br />-K— VERTICAL — HORIZONTAL — ANGLE —(SPECIFY) <br />DRILLING ROTARY <br />METHOD FLUID Mud <br />Describe material, grain, size, color, etc. <br />WELL OWNER <br />Name Moorman's Water Systems <br />CASING (S) <br />Mailing Address 2120 Wilcox Rd <br />Stockton <br />_ _ <br />CA 95215 <br />CITY <br />Address 830 W BowmandLL LOCATIO <br />STATE ZIP <br />0 3 Top Soil <br />3 <br />6 <br />Hard Pan <br />City French Camp CA <br />6 <br />10 <br />Sand <br />County San Joaquin <br />155 175 <br />10 <br />18 <br />Clay <br />APN Book Page Parcel <br />Township Range Section <br />Latitude � I <br />DEG. MIN. SEC. <br />LOCATION SKETCH <br />NORTH <br />SOUTH <br />Illustrate or Describe Distance of Well from Roads, Buildings, <br />Fences, Rivers, etc. and attach a map. Use additional paper if <br />necessary. PLEASE BE ACCURATE & COMPLETE. <br />_ <br />I , <br />DEG. MIN. SEC. <br />ACTIVITY (-V) <br />__VL' NEW WELL <br />MODIFICATIONIREPAIR <br />— Deepen <br />— other (Specify) <br />PErocedures aDnd Materials <br />Under "GEOLOGIC LOG' <br />PLANNED USES(+) <br />WATER SUPPLY <br />Domestic _ Public <br />Irrigation _ Industrial <br />MONITORING — <br />TEST WELL <br />ATHODIC PROTECTION— <br />HEAT EXCHANGE—. <br />DIRECT PUSH_._ <br />INJECTION — <br />VAPOR EXTRACTION — <br />SPARGING <br />REMEDIATION _ <br />OTHER (SPECIFY)— <br />18 24 Sand <br />24 75 Soft Clay <br />75 93 Brown Clay <br />93 94 Sand <br />94 113 Brown Clay <br />113 118 Brown Sand <br />118 123 Clay <br />123 126 Brown Sand <br />126 154 Clay <br />154 170 Brown Sand <br />170 190 Clay <br />WATER LEVEL & YIELD OF COMPLETED WELL <br />DEPTH TO FIRST WATER (Ft.) BELOW SURFACE 1 <br />DEPTH OF STATIC <br />WATER LEVEL 18 (FL) & DATE MEASURED 7/17/2017 <br />ESTIMATED YIELD ' (GPM) & TEST TYPE <br />TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br />Mav not be representative o a well's lon -term yield. <br />TOTAL DEPTH OF BORING 190 (Feet) <br />TOTAL DEPTH OF COMPLETED WELL 175 (Feet) <br />DEPTH <br />FROM SURFACE <br />Fl. to Ft. <br />BE <br />DIA. <br />(Inches) <br />CASING (S) <br />DEPTH <br />FROM SURFACE <br />ANNULAR MATERIAL <br />TYPE <br />CE- BEN - <br />MENT TONT FILL FILTER PACK <br />✓ (✓) UI-)(TYPE/SIZE) <br />TYPE !) <br />Y wa MATERIAL / INTERNAL GAUGE SLOT SIZE <br />Z p GRADE DIAMETER OR WALL IF ANY <br />m v LL (Inches) THICKNESS (Inches) <br />Ft to Ft. <br />0 155 <br />12 <br />155 175 <br />.0 <br />`� <br />GRAVEL <br />ATTACHMENTS (4) CERTIFICATION STATEMENT <br />— Geologic Log 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 />— Geophysical Log(s) (PERSON, FIRKR CORPORAT ) (TYPEDPRINTED) <br />— Soil/Water Chemical Analysis 11 I RdF5FFffi MOdeStO A 5357 <br />— Other ADDRESS CITY STATE ZIP <br />ATTACH ADDITIONAL INFORMATION, IF IT EXISTS. Signed 07/24/17 668622 <br />WELL DRILLER/AUTHORIZE(g.RESE1j.ATIVE r DATE SIGNED C-57 LICENSE NUMBER <br />.R 188 REV. I1-97 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />