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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORTi l I l i I l l i <br /> Page I of I Refer to Instruction Pamphlei STATE WELL NO./STATION NO. <br /> Owner's Well No. 95215 No.e0343316 ❑ <br /> Date Work Began 5/25/2017 Ended5/30/2017 _. LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health <br /> 77403 5/8/2017 APN/TRStOTHER <br /> Permit No. Permit Date _ <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) _V_VERTICAL _HORIZONTAL —ANGLE —(SPECIFY) Name Moormans Water Systems <br /> DRILLING ROTARY <br /> DEPTH DESCRIPTION <br /> FROM METHOD FLUID Mud Mailing Address 2120 Wilcox Rd <br /> Stockton CA 95215 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 2007 Patterson 91 <br /> LL LOCATIO <br /> 3 30 Clay City Stockton CA 95215 <br /> 30 38 Shale County San Joaquin <br /> 38 701 Sand and Gravel APN Book Page Parcel <br /> 70 105 Clay Township Range Section <br /> 105 117 Sand Latitude I 1 1 <br /> 117 138 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 138 145 Sand LOCATION SKETCH ACTIVITY ) <br /> NORTH -3L NEW WELL <br /> 145 150 Clay MODIFICATION/REPAIR <br /> 150 155 Sand —ape„ <br /> 155 160 Clay —Other(Specify) <br /> 160 163 Sand <br /> scribe <br /> 163 185 Clay — DESTROY <br /> (and Materials <br /> Under"GEOLOGIC LOG' <br /> 185 190 Sand PLANNED USES(.+.) <br /> 190 207 Clay WATER SUPPLY <br /> 207 210 Sand — Domestic— Public <br /> uj co <br /> 210 231 Clay — Irrigation _ Industrial <br /> 231 234 Sand MONITORING— <br /> TEST WELL_ <br /> 234 257 Shale ATHODIC PROTECTION—_ <br /> 257 260 Sand RE CEIVED HEAT EXCHANGE- <br /> 260 264 Clay DIRECT PUSH_ <br /> 264 265 Sand INJECTION— <br /> 265 270 ClayVAPOR EXTRACTION— <br /> SPARGING_ <br /> 270 276 Sand SOUTH REMEDIATION— <br /> Illustrate or Describe Distance of Well from Roads, Buildings, <br /> 276 286 Clay Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)_ <br /> 286288 Sand DEPARTMENT <br /> necessary. PLEASE BE ACCURATE & COMPLETE. <br /> 288 3001 Clay WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER 114 <br /> - (Ft.)BELOW SURFACE <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft.)&DATE MEASURED <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 300 (Feet) TEST LENGTH <br /> TOTAL DEPTH OF COMPLETED WELL28 (Feet)0 (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> M not be representative of a well's tori -term yield <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE TYPE FROM SURFACE TYPE <br /> DIA. Y a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) g U v GRADE DIAMETER OR WALL IF ANY FILTER PACK <br /> Ft. to Ft. <br /> m rn LL (Inches) THICKNESS (Inches) Ft. to Ft. MENT T(O�j L) (TYPE/SIZE) <br /> 0 260' 11 <br /> 260 280 4 '� GRAVEL <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> — Geologic Log 1,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 OR CORPORATW) & D) <br /> — Soil/Water Chemical Analysis 119 R M tCA 95357— Other ADDRESS CITY STATE ZIP <br /> ATTACHADDITIONALINFORMATION,IFITIXISTS. Signed 05/30/17 568622 <br /> WELL DRIL I DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE N ONSECUTIVELY NUMBERED FORM <br />