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TRIPLICATE STATE OF CALIFORNIA <br />Oamees Copy WELL COMPLETION REPORT <br />Page l of 2 Refer to Inrtnec wit Panp Net <br />O"er's Weu No. 95236 No -e0354327 <br />Date Work Began 10/58017 Ended <br />Local Permit Agency Fnvimnmental Health <br />Permit No. wp0036991 Pemut Date 8/3/2017 <br />DWR USE ONLY — DO NOT FILL IN <br />STATE WELL NO.t STATION NO. <br />LATITUDE LONGITUDE <br />APWTRSIOTHER <br />GMIAX.iJU LUG <br />ORIENTATION (2) -aL VERTICAL — HORIZONTAL — ANGLE—(sPECIFI) <br />DRILLING ROTARY <br />DEPTH FROM METHOD FLUID Mud <br />SURFACE DESCREMON <br />Ft to FL Describe malertal, grain, itze, Color, etc. <br />WELL OWNER <br />Name CalossO Dondero Investments <br />(S) <br />Mailing Address 20480 E- Coopgronlois Rd <br />Linden <br />CA 95236 <br />CITY <br />Address 23757 E. Chris LWnELL LOCATIO <br />STATE ZIP <br />0 3 Top Soil <br />3 <br />5 Hard Pan <br />City Linen CA 95236 <br />24 <br />5 <br />131 Clay <br />County San JoaQuin <br />13 <br />21 Gravel <br />APN Book Page Parcel <br />Township Range Section <br />Latitude I <br />DEG. MIN. SEC. <br />LOCATION SKETCH <br />NORTH <br />N <br />SOUTH <br />10—ft re or D�be Duman of W.11J.— Road, Bnl&W, <br />Fmcoi Rivwkdc. sod Wath • map. Unadditiarl pqw if <br />accom y. PtEAse to ACCURATE dt COMPLETC <br />I <br />DEG. MIN. SEC. <br />ACTIVITY (v—) <br />-..Vo–' NEW WELL <br />MODIFICATIONIREPAIR <br />— Deep - <br />— Odw (specify) <br />—.. DESTROY (Doo be <br />Prooeium end MaterWs <br />UrKW'GEOLOGIC LOG <br />PLANNED USES(-,(-) <br />WATER SUPPLY <br />oon*mc — Pic <br />__x/ knoaeDn — Irm-wal <br />MONITORING — <br />TESTWELL <br />THODIC PROTECTION_. <br />HEAT EXCHANGE_. <br />DIRECT PUSH - <br />INJECTION <br />VAPOR EXTRACTION _ <br />SPARGING- <br />REMEDIATION <br />OTHER (SPECIFY) - <br />21 25 Cl <br />25 28 Gravel <br />28 33 <br />-Clay <br />33 36 Gravel and Rocks <br />36 681 Clay <br />68 88 Gravel <br />88 148 Clay <br />148 168 Sand <br />168 192 Clay <br />192 198 Sand <br />198 210 Clay <br />210 216 Sand <br />216 2231 Clay <br />223 226 Black Sand <br />226 243 Clay <br />243 248 Black Sand <br />248 252 Shale <br />252 268 Black Sand <br />268 283 Clay <br />283 288 Black Sand <br />288 297 Shale <br />297 298 Black Sand <br />296 <br />370 Clay <br />WATER LEVEL & YIELD OF COMPLETED WELL <br />DEPTH TO FIRST WATER--- (Ft.) BELOW SURFACE <br />DEPTH OF STATIC <br />WATER LEVEL (Ft.) a DATE MEASURED <br />ESTIMATED YIELD ' (GPM)E TEST TYPE <br />TEST LENGTH (Hra.) TOTAL DRAWDOWN (Ft) <br />May not be re sewative o a well's lon -term yield <br />370 372 Black Sand <br />372 385 Shale <br />385 386 Shale <br />TOTAL DEPTH OF BORING 6W (FW) <br />TOTAL DEPTH OF COMPLETED WELL 580 (Feet) <br />DEPTHCASING <br />FROM SURFACE <br />How <br />(S) <br />DEPTH ANNULAR MATERIAL <br />FROM SURFACE TYPE <br />DIA. <br />hl4l ERIA! / INTERNAL GAUGE SLOT SIZE <br />ffTjE-11 <br />GRADE DIIAn&es) TETER NCKNESS (IR WALL FANY nct—) <br />CE- 8ENFL <br />FL to Ft MENT TON FIL! FILTER PACK <br />(✓) ( �} (TYPE/SIZE) <br />to Ft. <br />0 400 <br />24 <br />L sTrmr=L 16 114 <br />0 50 ✓ <br />400 580 <br />.080 <br />so 580 GRAVEL <br />ATTwctrMFNTs (,�) <br />CERTIFICATION STATEMENT <br />— Gsotopo Lap <br />I. the tardersWed, osrtfy Ifrd tWx report K canpbfe and accurate to the best of my larawledpe and baler. <br />— ww cowhicilon DMW= <br />NAME_NWSELLIS DRILLING INC <br />Geophysical Lops) <br />(PERSON, FIR CORPORATI <br />(Tl: ED PRINTF -0).,&R <br />er <br />— SdNV& Chemical Annyais <br />Otlur <br />ADDRESS N111IFCITY STATE ZIP <br />— <br />ATTACHAWMIDNALWFORMA7r0N,IFITEXISTS. <br />1010/17 M22WELL DRf A 71VE I DATE SIGNED C-57 LICENSE NUMBER <br />DWR IN REV. 11-97 IF ADDrnONAL SPACE IS NEEDED, USE NEXTDONSECUTIVELY NUMBERED FORM <br />