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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 2 of 2 Refer to Instruction Pamphlet STATE WELL NO./STATION N0, <br /> Owner's Well No. 95358 No-e0364002 <br /> Date Work Began 2/12/2018 , Ended2/20/2018 _ _ LATITUDE LONGITUDE ❑ <br /> Local Permit Agency Environmental H .alth <br /> Permit No.-WP0037444 Permit Date 10/17/2017 APN/rRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION VERTICAL —HORIZONTAL — ANGLE —(SPECIFY) Name Paul McManis <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID MUD Mailing Address 6303 Beckwith Rd <br /> 'SURFACEDESCRIPTION Modesto CA 95358 <br /> Ft. to Ft Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 502 509 Shale N' L LOCATIO <br /> 509 535 Black Sand Address 28755 Dry Creek FII <br /> City Galt CA <br /> 535 538 Shale County San Joaquin <br /> 538 557 Black Sand APN Book Page Parcel . <br /> 557 559 Shale Township Range Section <br /> 559 624 Black Sand Latitude t 1 l <br /> 624 628 Shale DEG. MIN. SEC. DEG. MIN. SEC. <br /> 628 660 Black Sand LOCATION SKETCH ACTIVITY (v) <br /> NORTH V NEW WELL <br /> MODIFICATION/REPAIR <br /> —Deepen <br /> —Other(Specify) <br /> — DESTROY(Describe <br /> Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> PLANNED USES() <br /> F WATER SUPPLY <br /> cn y Domestic— Public <br /> Q Irrigation _ Industrial <br /> ut MONITORING— <br /> TEST WELL <br /> ATHODIC PROTECTION_ <br /> HEAT EXCHANGE— <br /> DIRECT PUSH__ <br /> INJECTION— <br /> VAPOR EXTRACTION—. <br /> SPARGING <br /> SOUTH REMEDIATION_ <br /> Illustrate or Describe Distance of Bell 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 <br /> DEPTH OF STATIC <br /> WATER LEVEL 158.1 (Ft.)B DATE MEASURED 2/20/2018 <br /> TOTAL DEPTH OF BORING 660 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN <br /> (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL 660 (Feet) May not be representative o a well's Ion -term yield <br /> DEPTHCASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE ffEv' FROM SURFACE TyDIA. MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft to Ft. (Inches) THICKNESS (Inches) Ft to Ft. (✓) U (TYPE/SIZE) <br /> 0 460 24 ./ <br /> 460 660 '� RAVE <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> — Geologic Log I,the undersigned,certify that this report is complete and accurate to the hest of my knowledge and belief. <br /> Well Construction Diagram NAME MASELLIS DRILLING INC <br /> — Geophysical Log(s) (PERSON,FIRM,OR CORPORATION) (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 11 A 95357 <br /> Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS Signed 03/23/18 668622 <br /> WELL U H DT rATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />