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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page I of 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95320 No-e0367530 ❑ ❑ <br /> Date Work Began 6/5/2018 Ended6/6/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Fnvironmental Health _ <br /> Permit No. wp0038032 Permit Date 3/9/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Hendrick Riemersma <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 1620 James St <br /> SURFACEDESCRIPTION Escalon CA 95320, <br /> Ft. to Ft. Describe material grain, size, color, etc. CIN STATE ZIP <br /> 0 4 Top Soil Address 30956 Grooms ffcrLL LOCATIO <br /> 4 8 Sand City Oakdale CA 95361 <br /> 8 13 Hard Pan county San Joaquin <br /> 13 18 Sand APN Book Page Parcel _ <br /> 18 28 Clay Township Range Section <br /> 28 32 Sand Latitude I t I <br /> 32 38 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 38 50 Sand LOCATION SKETCH ACTIVITY (✓_) <br /> Sand <br /> NORTH —.%/— NEW WELL <br /> 50 68 MODIFICATION/REPAIR <br /> 68 73 Sand _ape„ <br /> 73 77 Clay —Other(Specify) <br /> 77 81 Gravel <br /> 81 98 Clay —Procedures(Describe <br /> nd Materials <br /> Under"GEOLOGIC LOG' <br /> 98 108 Sand PLANNED USES() <br /> 108 1501 Clay WATER SUPPLY <br /> 150 160 Sand W Domestic— Public <br /> 160 184 Shale 3 litigation Industrial <br /> 184 188 Sand MONITORING— <br /> TEST WELL— <br /> 188 203 Clay ATHODIC PROTECTION_ <br /> 203 205 Sand HEAT EXCHANGE- <br /> 205 225 Shale DIRECT PUSH- <br /> 225 240 Clay INJECTION— <br /> 240 241 Sand VAPOR EXTRACTION — <br /> SPARGING <br /> 241 270 Clay SOUTH REMEDIATION_. <br /> Illustrate or Describe Distance of Well from Roads, Buildings, <br /> 270 273 Sand Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)_ <br /> 273 278 Clay aeceaaary. PLEASE BE ACCURATE & COMPLETE. <br /> 278 283 Sand WATER LEVEL&YIELD OF COMPLETED WELL <br /> 283 300 Shale DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> DEPTH OF STATIC <br /> WATER LEVEL 102 (Ft.)&DATE MEASURED 6/6/2018 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE _ <br /> TOTAL DEPTH OF BORING 300 (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 287 (Feet) Mav not be representative of a well's lon -term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE � FROM SURFACE TYPE <br /> DIA. 2 w a MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) O GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft. to Ft. m v LL (Inches) THICKNESS (Inches) Ft to Ft (TYPE/SIZE) <br /> 4 (`0 U _ <br /> 0 267 12 <br /> 267 287 115 287 GRAVEL <br /> ATTACHMENTS (y) 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,FIRM,OR CORPORAWON) TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 Albers Rd' _ Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,1F IT EXISTS. Signed 06/07/18 668622 <br /> WELL DRILLERIAUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11.97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />