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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT F-jilil 1i Ili <br /> Page 1 of 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95242 NO.e0366497 <br /> Date Work Began 4/24/2018 Ended4/27/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health _ _ <br /> Permit No. wp0038096 Permit Date 3/27/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL _HORIZONTAL — ANGLE —(SPECIFY) Name Marco Pires <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID MUD Mailing Address 23381 N. Devries Rd <br /> SURFACEDESCRIPTION Lodi CA 95242 <br /> Ft. to Ft Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 11200 E. Liberty ffj,L LOCATIO <br /> 3 37 Sand City Galt CA <br /> 37 52 Clay County San Joaquin <br /> 52 71 Sand APN Book Page Parcel <br /> 71 133 Clay Township Range Section <br /> 133 135 Sand Latitude i 1 1 <br /> 135 145 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 145 149 Sand LOCATION SKETCH ACTIVITY (✓) <br /> 149 162 Clay NORTH NEW WELL <br /> FICATION/REPAIR <br /> MODI <br /> 162 164 Sand —Deepen <br /> 164 179 Clay —Other(Specify) <br /> 179 192 Shale <br /> DESTROY 192 219 Clay — Procedures escribe a0nd Materials <br /> Under"GEOLOGIC LOG' <br /> 219 220 Sand PLANNED USES(-L) <br /> 220 269 Clay WATER SUPPLY <br /> 269 270 Sand W h Domestic — Public <br /> 270 280 Clay Irrigation _ Industrial <br /> — <br /> 280 281 Sand MONITORING <br /> TEST WELL- <br /> 281 330 Clay ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH_ <br /> INJECTION— <br /> VAPOR EXTRACTION—. <br /> SPARGING <br /> SOUTH REMEDIATION_ <br /> lllusimte or Describe Distance of Well from Roads, Butldings, <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)— <br /> necessary. PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STATIC <br /> WATER LEVEL 150 (Ft.)&DATE MEASURED 4/27/2018 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 330 (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 300 (Feet) May not be representative o a well's lon -termyield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE __TYPE ! FROM SURFACE TYPE <br /> DIA. Y w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- jT1 <br /> Ft. to Ft. (Inches) g p a GRADE DIAMETER OR WALL IF ANY FILTER PACK <br /> m <br /> u- <br /> 0 <br /> (Inches) THICKNESS (Inches) Ft. to Ft. ME ILL <br /> �) (TYPE/SIZE) <br /> 0 210 11 <br /> 210 230 .045 100 300 GRAVEL <br /> 230 250 <br /> 250 300 <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 CORPORATION) (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 Albers Rd 41111"1. • Modesto CA 95357 <br /> — Other ADDRESS $ ,a.¢ r p z CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 04/30/18 668622 <br /> WELL DRILLFR1AUTHOAZED,REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.I1-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT'CONSECUTIVELY NUMBERED FORM <br />