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TRIPLICATE STATE OF CALIFORNIA <br />Owners Copy WELL COMPLETION REPORT <br />Page 2 of 2 Refer to hatrwam Pamphlet <br />Owner's Well No. 95236 No.o0354327 <br />Date Work Began 10/512017 EIS <br />Local Permit Agency FnvirnnmPrdal Health <br />Permit No. wpoo36991 __ Permit Date 8/3/2017 <br />DWR USE ONLY DO NOT FILL IN <br />STATE WELL NO.I STATION NO. <br />❑ 1 1 1 L -D❑ <br />_LATITUDE LONGITUDE <br />CII�IIIIIIIIiI <br />APNfRSIOTHER <br />ORIENTATION (-Y–') <br />DEPTH FROM <br />SURFACE I <br />Ft to Ft. I <br />(iEUL GIC LOG <br />-AL VERTICAL — HORIZONTAL —. ANGLE —(SPECIFY) <br />DRILLING ROTARY <br />METHOD FLUID Mud <br />DESCRIPTION <br />Dexribe malerW, grlottt, size, color, etc. <br />WELL OWNER <br />Name Calosso Dondem Investments <br />DEPTH ANNULAR MATERIAL <br />FROM SURFACE TYPE_ <br />CE'BEN <br />PACK <br />MENT 7pN FILLFt <br />Ft to FI. (� (J (TYPEISIZE) <br />Mailing Address 20480 E. ConneroDlois Rd <br />Linden <br />CA 95238 <br />CIT'( <br />Address 23757 E. Chris rLL LOCATION <br />STATE ZIP <br />386 408 Black Sand <br />408 <br />411 <br />Shale <br />Cit, Linen CA 95236 <br />50 580 GRAVEL <br />411 <br />418 <br />Black Sand <br />County San Joaquin <br />418 <br />424 Shale <br />APN Book Page Parcel <br />Township Range Section <br />Latitude I <br />DEG. MIN. SEC. <br />LOCATION SKETCH <br />NORTH <br />F <br />�N <br />SOUTH <br />/ILmesr or Osavibe Duff o of WtH fI m Rands. EMtd ftt <br />Fane, Rivas, etc. *Ed sn@cb a wap. Use edd6orl' pepar if <br />eec a ). PEASE Q ACCURATE • C'ONlrl.t <br />I <br />DEG. MIN. SEC. <br />ACTIVITY (! ) <br />V NEW WELL <br />EPAIR <br />Morn— D"Pen <br />— DO- (Sp") <br />DESTROY (DescrUe <br />Pmcedre@ NO MebrWa <br />Under *GEOLOGIC L <br />PLANNED USES (AC ) <br />WATER SUPPLY <br />Do mbc — PLac <br />Irrlgehon InduWW <br />LLl MONITORING -- <br />TEST WELL_ <br />THODIC PROTECTION— <br />HEAT EXCHANGE._._. <br />DIRECT PUSH_ <br />INJECTION — <br />VAPOR EXTRACTION __._ <br />SPARGING _. <br />REMEDIATION — <br />OTHER (SPECIFY)— <br />424 446 Black Sand <br />446 483 Shale <br />483 499 Black Sand <br />499 508 Shale <br />506 510 Black Sand <br />510 530 Clay <br />530 545 Blade Sand <br />545 555 Shale <br />555 574 Black Sand <br />574 580 Shale <br />WATER LEVEL & YIELD OF COMPLETED WELL <br />DEPTH TO FIRST WATER- (FL) BELOW SURFACE <br />DEPTH OF STATIC <br />WATER LEVEL (Ft) 6 DATE MEASURED <br />ESTIMATED YIELD (GPM)& TEST TYPE <br />TEST LENGTH (Hm.) TOTAL DRAWDOWN (Ft) <br />May not be rr ntattIv ofa well's lon tsrnt vield <br />TOTAL DEPTH OF BORING 580 (Fee) <br />TOTAL DEPTH OF COMPLETED WELL 580 (Fee) <br />DEPTH <br />FROM SURFACE <br />HSE <br />DIA <br />(IrIcM@) <br />CASING (S) <br />DEPTH ANNULAR MATERIAL <br />FROM SURFACE TYPE_ <br />CE'BEN <br />PACK <br />MENT 7pN FILLFt <br />Ft to FI. (� (J (TYPEISIZE) <br />TYPE ! <br />SLOT SIS <br />W MATERIAL 1 INTERNAL71�CR' <br />f SFILTER <br />w GRADE DWIETER IF ANY <br />8(Incfxs) (Inch*@) <br />to Fl. <br />0 400 <br />24 <br />I/ <br />400 5801 <br />.080 <br />50 580 GRAVEL <br />ATTACHMENTS ( 3) <br />— G@obpc Lug <br />w@e caa&LK an DWV–. <br />— Geoph>'Ncr ing(*) <br />- <br />�.- So61WOW ChankM Ar*fI <br />oalw <br />ATTACH ADO/TIONAL MIFORMATION, IF IT EXISTS.Somid <br />CERTIFICATION STATEMENT <br />1. h@ Ind@re W *d, er* IMS V* (apart is conlpl@t* wd w=xvW to If* bel d nV We~ end bob <br />NAME MASEWS DRILLING INC <br />(PERSON, FIRM, CORPORA ED OR INTED), <br />lgAllmn; Rd 95357 <br />ZIP <br />aTY STATE Z <br />10/t7fl17 668822 <br />WELL. DRI SENT DATE SIGNED GS7 LICENSE NUMBER <br />DWR IR! REV. 11-97 IF ADDFIONAL SPACE 15 NEEDED, USE NEXT CON5tGUI IVtLT NUMt5I:Kt=U I`VKM <br />