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QUADRUPLICATE STATE OF CALIFORNIA DUSE ONLY — DO NOT FILL IN <br /> WR <br /> For Local Requirements WELL COMPLETION REPORT 1 1 1 1 1 1 1 1 11 17 <br /> Page 1 of 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95236 No.e0366499 <br /> Date Work Began 4/26/2018 Ended5/4/2018 LATITUDE LONGITUDE <br /> Local Permit Agency EnvironmBintal HFalth _l__I I I I I I I 1 _ 1 1___ <br /> Permit No. wp0038031 Permit Date 3/9/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Jeanette Sanquinetti <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID MUD Mailing Address 18704 E. Copperopolis Rd <br /> SURFACEDESCRIPTION Linden CA 95236 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 18704 E.Cop pe or pods �ATIO <br /> 3 15 Sand City Linden CA 95236 <br /> 15 72 Clay CountySan Joaquin <br /> 72 841 Sand APN Book Page Parcel <br /> 84 141 Clay Township Range Section <br /> 141 156 Sand Latitude i 1 <br /> 156 165 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 165 191 Shale LOCATION SKETCH ACTIVITY (v—) <br /> NORTH __V_0' NEW WELL <br /> 191 204 Sand MODIFICATION/REPAIR <br /> 204 220 Shate —Deepen <br /> 220 221 Sand —other(Specify) <br /> 221 225 Clay <br /> — DESTROY(Describe <br /> 225 230 Sand Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> 230 237 Shale PLANNED USES() <br /> 237 242 Sand and Gravel WATER SUPPLY <br /> 242 253 Clay v~i ; Domestic— Public <br /> 253 266 Sand Irrigation _ Industrial <br /> 266 281 Clay MONITORING— <br /> TEST WELL <br /> 281 285 Sand ATHODIC PROTECTION- <br /> 285 297 Shale HEAT EXCHANGE- <br /> 297 308 Sand DIRECT PUSH- <br /> 308 345 Shale INJECTION— <br /> VAPOR EXTRACTION_ <br /> SPARGING— <br /> SOUTH REMEDIATION— <br /> Illustrate or Descnbe Distance of Well from Roads, Buildings, <br /> Fences,Rivers,etc. and attach a map. Use additional paper it OTHER(SPECIFY)— <br /> necessary.PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (FL)BELOW SURFACE 1 <br /> DEPTH OF STATIC <br /> WATER LEVEL 138 (Ft.)&DATE MEASURED 5/4/2018 <br /> TOTAL DEPTH OF BORING 345 ESTIMATED YIELD • (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN <br /> (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 310 (Feet) May not be representative o a well's lon -term vield <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLETYPE FROM SURFACE TYPE <br /> DIA. x w g MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft to Ft. (inches) g W p a GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> m LL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ ✓ ✓ (TYPE/SIZE) <br /> (_) U <br /> 0 290 11 <br /> 290 310 ✓ 100 310 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 IUC <br /> Geophysical Log(s) (PERSON,FI I N) D) <br /> SoiWVater Chemical Analysis 119 Albers <br /> Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT DCISTS. Signed a 04/30/18 668622 <br /> if WELL DRILLER/AUTHORIZ EPRES TATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />