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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY - DO N T FI L IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Refer to Instruction Pamphlet STATE WELL N0.1 STATION NO. <br /> Page a of 1 No e0304189 -E CI —L L � <br /> Owner's Well No. 95320 <br /> Date Work Began <br /> 3/16/2016 Ended3/21/2016 LATITUDE LONGITUDE <br /> Local Permit Agency F IdMnnaental.- APNITRSIOTHER <br /> Permit No. 74391 Permit Date 3/10/2016 <br /> GEOLOGIC LOG WELL OWNER <br /> DR—.-VEFMCAL —HORIZONTAL ANGLE —(SPECIFY) Name George TeVelde - <br /> ORIENTATION(__1 I <br /> ) Mailing Address X2_7_81`�odda� <br /> METHOD ROTARY FLUID.Mud o CA 95320 <br /> pEPTH FROM DESCRIPTION Escalon <br /> Describe material, grain, size, color, etc. CITY STATE ZIP <br /> Ft. to Ft. LL LOCATIO <br /> 0; 2 Top Soil _ Address 21750 E. River <br /> 2; 15 Sand - - - ___-- City Edon CA 95320 <br /> 15; 43 Clay _ CountyS_an Joaquin <br /> 43: 51 i Sand - APN Book Paige. Panel <br /> 51' 63!Clay _ 'Township Range Suction <br /> 63 78:Sand _ Latitude <br /> 78 107 Cla _ DEG. MIN. SEC. DEG. MIN. SEC. <br /> �— - - LOCATION SKETCH ACTIVITY ) <br /> 107 i 135 Sand _ - NORTH _6 NEW WELL <br /> 135 146 'Clay _. _ MODIFICATIOWREPAIR <br /> 14$' 154 Sand _.. Deepen <br /> --Other(Specify) <br /> 154158'.,Clay <br /> 158 162;Sand DESTROY( <br /> -- Procedures Deserve . <br /> — -- als <br /> 162 164:Clay Under GEOLOGIC LOG" <br /> 164~ 1671 Sand PLANNED USES(-/) <br /> 167 _172 Clay .- - WATER SUPPLY <br /> l'- Domestic -- Public <br /> 172; 174''.Sand w Imgstion InduslInal <br /> 174 182 Clay MONITORING— <br /> 1$2 1$5:Sand TEST WELT— <br /> 185 198 Clay Y ATHODIC PROTECDON- <br /> 198 200�Sand _ HEAT EXCHANGE <br /> 2--���� 213 ril'dy DIRECT PUSH <br /> _--_. INJECTION— <br /> 213; i 216 Sand— VAPOR EXTRACTION— <br /> 216 218 Clay --- SPARGING- <br /> 218; 220 Sand - SOUTH - - ---- - REMEDIATION, <br /> 111as1vte or Describe Distance of We11 from Nuuds. H-Idmgs, <br /> 220 235 Clay Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)— <br /> , a wmary. PLEASE DE ACCURATE & COKPLET'E. <br /> - - WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STAT cg 3118f2016 <br /> -- -- - WATER LEVEL.- (Ft.)&DATE MEASURED .. <br /> - - --`— ESTIMATED YIELD '_ - - (GPM)& TEST TYPE <br /> TOTAL DEP 1I OF BORING 235 (Feet) TEST LENGTH_---..—(Hrs.) TOTAL DRAWDOWN iFt7 <br /> TOTAL DEPTH OF COMPLETED WELL 227 (Feet) Alay not be M Msentative o a well's long-term yield. <br /> DEPTHBORE CASING(S) DEPTH ANNULAR MATERIAL -- <br /> FROM SURFACE }(OLE TYPE (�I _ FROM SURFACE E <br /> DIA <br /> a MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN <br /> z w z 1- a i DIAMETER OR WALL IF ANY FILTER PACK <br /> Ft to Ft (Inds) m p GRADE (I ) THICKNESS (Indies) Ft. to Ft MENT TONT FILL (TYP€ISIZE) <br /> O, 207 12 PLAST _ <br /> 207; 227 100 227 GRAVEL- <br /> ATTACHMENTS (,e CERTIFICATION STATEMENT <br /> .— Geologic Log 1.the undersigned,certify that this report is complete and accurate to the best or my knowledge and belief. <br /> Well Construction Diagram NAME MASELLIS DRILLING INC <br /> — Geophysical Log(s) (PERSON,FIRM,OR AMPORATION) ED OR PRI TED) 1 N deSt _� 95357 <br /> — SoiV Water Chemical Analysis 119 Albers Rd - - - <br /> ADDRESS CITY STATE ZIP <br /> Other 03/21/16 668622 <br /> ATTACH At)D,ITIONAC INFORMATION,IF IT EXSTS s9ned <br /> WELL DRILLERIAUTHORIZED RE NTAT DATE SIGNED _ C-57 LICENSE NUMBER <br /> DWR-Iso REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />