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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 NO. <br /> Owner's Well No. 95236 No.e0358712 <br /> Date Work Began 11/9/2017 Endedl l/22/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I I I I I I I I II <br /> Permit No. WP0036990 Permit Date 8/3/2017 APN/IRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) V VERTICAL HORIZONTAL —ANGLE —(SPECIFY) Name R&J Dondero <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 20480 E. Copperopolis Rd <br /> SURFACEDESCRIPTION Linden CA 95236 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 407 4101 Black SandWELL LOCATION <br /> 410 431 Shale Address 15723 E Hwy 26 <br /> City Linden CA 95236 <br /> 431 434 Sand County San Joaquin <br /> 434 442 Shale APN Book Page Parcel <br /> 442 449 Sand and Gravel Township Range Section <br /> 449 470 Shale Latitude I I <br /> 470 478 Black Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 4781 494 Shale LOCATION SKETCH ACTIVITY �) <br /> NORTH __V_1' NEW WELL <br /> 494 497 Black Sand MODIFICATION/REPAIR <br /> 497 500 Shale —Deepen <br /> 500 510 Black Sand —other(Specify) <br /> DESTROY (Describe <br /> Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> PLANNED USES <br /> WATER SUPPLY <br /> u) Domestic Public <br /> Lu ¢ Inigation — Industrial <br /> ul MONITORING— <br /> TEST WELL <br /> — <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 Well 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 <br /> DEPTH OF STATIC <br /> WATER LEVEL 143 (Ft.)&DATE MEASURED 11/22/2017 <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 510 (Feet) TEST LENGTH <br /> TOTAL DEPTH OF COMPLETED WELL 510 Feet (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> (Feet) May not be representative of a well's lon -term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BOE TYPE I FROM SURFACE TYPE <br /> DIA. Y w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z w p a GRADE DIAMETER OR WALL IF ANYFILTER PACK <br /> Ft. to Ft. m v (Inches) THICKNESS (Inches) Ft. to Ft. "ENT TON) FILL m pEISIZE) <br /> to LL "_1 (`�) 06 <br /> 0 310 24 p 50 <br /> 310 510 50 510 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,FIR CORP RATION) (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119AIbersRd <br /> — Other ADDRESSCITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. SignedNL�I12/11/17 668622 <br /> 11 WELL DRILLEFDAxfrHORIZEb REP ENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />