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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL N _ <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. 95366 No.e0356762 <br /> Date Work Began 10/26/2017 , Ended10/27/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Envimrimpntal HPnIth <br /> Permit No. 77660 Permit Date 6/6/2017 APN/rRSIOTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Suzanne Winters <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address P.O. BOX 115 <br /> SURFACEDESCRIPTION Ripon CA 95366 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil W L LOCATION <br /> 3 26 Sand and Gravel Address 21588 S Wagner <br /> 26 70 Clay City Ripon CA 95366 <br /> 70 80 Sand CountySan Joaquin <br /> APN Book Page Parcel <br /> 80 901 Clay Township Range Section <br /> 90 931 Sand <br /> Latitude 1 I <br /> 93 147 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 147 153 Sand LOCATION SKETCH ACTMTY L) <br /> NORTH --V—" NEW WELL <br /> 153 157 Clay <br /> 157 172 Sand MODIFICATION/REPAIR <br /> —Deepen <br /> 172 179 Clay —Other(Specify) <br /> 179 182 Sand <br /> — DESTROY(Describe <br /> 182 188 Clay Procedures and Materials <br /> 188 206 Sand Under"GEOLOGIC LOG' <br /> 206 214 ClayQ PLANNED USES(.)WATER SUPPLY <br /> 214 227 Sand Cl) 1 �' lh�_ Public rial <br /> 227 230 Clay <br /> — <br /> 230 248 Sand MONITORINGTEST WELL- <br /> 248 2951 Clay 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 /> eeeenary. 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 48 (Ft.)&DATE MEASURED 10/27/2017 <br /> TOTAL DEPTH OF BORING 295 ESTIMATED YIELD • (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 260 (Feet) I May not be representative o a well's long-term yield. <br /> DEPTH DEPTH BORE- CASING(S) ANNULAR MATERIAL <br /> _ <br /> FROM SURFACE HOLE TYPE FROM SURFACE TYPE <br /> DIA. Y w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) 5 W Z ° DIAMETER OR WALL IF ANY FIL <br /> O GRADE MENT TONTTER PACK <br /> Ft. to Ft. m 0v (Inches) THICKNESS (Inches) Ft. to Ft. FILL yPEJSIZE) <br /> 0 200 21 v PLASTIC 12 2an 0 56 1/ <br /> 200 260 `� 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 INC <br /> — Geophysical Log(s) (PERSON,FILM,OR CORPO ON) (TYPE OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 A • I sin a Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS, 11 Signed EPRE 11/10/17 668622 <br /> WELL DRI /A OR ' ATE <br /> SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NE)ff CONSECUTIVELY NUMBERED FORM <br />