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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REP( . <br /> Page I of I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95337 NO.e0364003 <br /> Date Work Began 2/8/2018 Ended2/24/2018 _ LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health <br /> Permit No. wp0037381 Permit Date 10/6/2017 APNrrRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) +� VERTICAL _HORIZONTAL — ANGLE (SPECIFY) Name Kathleen Kennedy <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID MUD Mailing Address 27474 Two Rivers Rd <br /> DESCRIPTION Manteca CA 95337 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 27474 Two Rive s%'l LOCATIO <br /> 3 18 Sand City Manteca CA 95337 <br /> 18 25 Clay County San Joaquin <br /> 25 65 Sand APN Book Page Parcel <br /> 65 71 Clay Blue Township Range Section <br /> 71 76 Sand Latitude I I <br /> 76 90 Brown Clay DEG. MIN, SEC. DEG. MIN. SEC. <br /> 90 96 Sand LOCATION SKETCH ACTIVITY L/) <br /> NORTH _1v' NEW WELL <br /> 96 100 Brown Clay <br /> MODIFICATION/REPAIR <br /> 100 114 Sand —Deepen <br /> 114 150 Brown Clay —other(Specify) <br /> 150 154 Fine Blue Sand <br /> 154 177 Blue Clay — °Eoced re(Describe <br /> Materials <br /> Under"GEOLOGIC LOG' <br /> 177 200 Sand PLANNED USES() <br /> 200 220 Blue Clay F WATER SUPPLY <br /> U) Domestic— Public <br /> Irrigation _ Industrial <br /> u1 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 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 13.6 (Ft.)&DATE MEASURED 2/24/2018 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 220 (Feet) <br /> TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 210 (Feet) May not be representative of a well's long-term yield. <br /> DEPTHCASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOETYPE ✓) FROM SURFACE TYPE <br /> DIA. Y w d MATERIAL/ INTERNAL GAUGE SLOT SIZE <br /> CE- BEN- <br /> (Inches) Z O o. GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft. to Ft. m 0 v a (Inches) THICKNESS (Inches) Ft. to Ft. ✓) (✓) �) (TYPE/SIZE) <br /> 0 90 22 ✓ <br /> 90 150 1 L <br /> 150 170 <br /> 170 210 <br /> ATTACHMENTS (2L) 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 FIRMoR ,..RPjJ I N) E Ef TfD) <br /> — SoillWater Chemical Analysis 119 AlbeModesto CA 95357 <br /> — Other ADDRESS tq } CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Sgt 03/23/18 668622 <br /> WELL DRILLER DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />