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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 1 of I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95236 No.e0344105 <br /> Date Work Began 6/2/2017 Ended6/7/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Fnvirnnmental RPSnttrCec <br /> P <br /> + <br /> Permit No. —Permit Date <br /> 77490 5/16/2017 APNITRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -.0'—VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Harold Jones <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 13745 E. Eight Mile Rd <br /> SURFACE DESCRIPTION Linden CA 95236 <br /> FL to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 5 Top Soil Address 13801 E. Eight 11�i eL NATIO <br /> 5 54 Clay City Linden CA 95236 <br /> 54 64 Sand County San Joaquin <br /> 64 76 Clay <br /> APN Book Page Parcel <br /> 76 78 Sand Township Range Section <br /> 78 81 Clay Latitude I I <br /> 81 88 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 88 107 Clay LOCATION SKETCH ACTIVITY (✓) <br /> NORTH -/ NEW WELL <br /> 107 115 Sand MODIFICATION/REPAIR <br /> 115 140 Clay —Deepen <br /> 140 150 Sand —Other(Specify) <br /> 150 165 Clay <br /> — <br /> DESTROY(Describe <br /> 165 174 Sand Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> 174 193 Clay PLANNED USES(.(-) <br /> 193 208 Sand WATER SUPPLY <br /> 208 245 Clay r~n ; Domestic— Public <br /> 245 250 Sand Irrigation — Industrial <br /> 250 262 j Clay MONITORING— <br /> TEST WELL— <br /> 262 263 Sand ATHODIC PROTECTION- <br /> 263 273 Shale HEAT EXCHANGE- <br /> 273 274 Sand DIRECT PUSH- <br /> 274 297 Clay INJECTION— <br /> VAPOR EXTRACTION— <br /> 297 310 Sand SPARGING_ <br /> JAN 18 4^ SOUTH <br /> t REMEDIATION <br /> Illustrate or Describe Distance of Well from Roads, Buildings, — <br /> Fences,Rivers,etc. and attach a reap. Use additional paper if OTHER(SPECIFY)— <br /> NIE I `L HEA necessary. PLEASE BE ACCURATE & COMPLETE. <br /> > •.1WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STATIC <br /> WATER LEVEL 142 (Ft.)&DATE MEASURED 6/6/2017 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 310 (Feet) TEST LENGTH <br /> TOTAL DEPTH OF COMPLETED WELL260Feet LENGTH—(Hrs.) TOTAL DRAWDOWN— (Ft.) <br /> (Feet) May not be representative o a well's Ion -term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOE aT,, FROM SURFACE TYPE <br /> DIA. MATERIAL/ INTERNAL GAUGE SLOT SIZECE- FTONITE <br /> - <br /> (Inches) GRADE DIAMETER OR WALL IF ANY MENTFILL FILTER PACK <br /> Ft. to Ft. (Inches) THICKNESS (Inches) Ft. to Ft. �) (TYPE/SIZE) <br /> to <br /> 0 240 12 pLASIIC; 200 0 100 <br /> 240 2601 .045 100 260 GRAVEL <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 IN <br /> Geophysical Log(s) (PERSON,FIRSNI C P P D TED) <br /> — Soil/Water Chemical Analysis 119 Albers Modesto CA 95357 <br /> — Other ADDRESS _' CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 06/07/17 668622 <br /> WELL DRILLER/AUTHORIZE PRESE ATIVE DATE SIGNED C57 LICENSE NUMBER <br /> DWR 188 REV.I1-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />