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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page I of I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95320 No.e0355170 <br /> Date Work Began 10/11/2017 EndedlO/13/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health _ . _1 1 1 1 1 1 1 1 1 1 1 1 I <br /> Permit No. wp0037361 Permit Date 9/27/2017 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) _V_VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Curt Maddex <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Eailing Address Mahon Rd CA 95320 <br /> SURFACEDESCRIPTION <br /> Ft. to FL Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top SoilWELL LOCATION <br /> 3 9 Hard Pan Address 28970 Kelly Rd <br /> Sand City Escalon CA 95320 <br /> 9 13 <br /> 13 23 Sand <br /> ClaCounty San Joaquin <br /> APN Book Page Parcel <br /> 23 43 Sand Township Range Section <br /> 43 65 Clay Latitude II <br /> 65 79 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 79 95 Gravel LOCATION SKETCH ACTIVITY (✓) <br /> 95 105 Clay NORTH __V_ NEW WELL <br /> 105 108 Gravel and Rocks MODIFICATION/REPAIR <br /> —Deepen <br /> 108 1151 Clay —Other(Specify) <br /> 115 135 Sand <br /> — DESTROY (Describe <br /> 135 236 Clay Procedures and Materials <br /> 236 237 Sand <br /> Under"GEOLOGIC LOG" <br /> PLANNED USES() <br /> 237 247 Clay WATER SUPPLY <br /> 247 273 Brown and Black Sand w __Z Domestic— Public <br /> 273 295 Clay — Irrigation — Industrial <br /> MONITORING— <br /> TEST WELL— <br /> ATHODIC PROTECTION_ <br /> HEAT EXCHANGE— <br /> DIRECT PUSH— <br /> INJECTION— <br /> VAPOR EXTRACTION — <br /> SPARGING_ <br /> SOUTH REMEDIATION— <br /> Illustrak or Describe Distance of R ell from Roads, Buildings, <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)— <br /> necessary. <br /> SPECIFY)_necessary. PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STAT C <br /> WATER LEVEL �2 (Ft.)&DATE MEASURED 10/13/2017 <br /> TOTAL DEPTH OF BORING 295 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (F�) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 280 (Feet) I May not be representative o a well's long-term yield. <br /> DEPTH BORE- CASING(S) ____ DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE �) FROM SURFACE PE <br /> DIA. x w z a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. to Ft. (Inches) g v a GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> m N LL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ ✓ (TYPE/SIZE) <br /> 0 260 105/8 <br /> 260 280 5 104 280 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 INC <br /> — Geophysical Log(s) (PERSON,FIRM CORPORATI (TYP7D OF <br /> RINTEq) <br /> — Soil/Water Chemical Analysis 11 RFluor A 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 10/23/17 668622 <br /> 11 WELL DRILLER/AUTHORIZEDRESENIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />