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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 1 of 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95215 No-e0366504 <br /> Date Work Began 4/24/2018 Ended4/25/2018 _ LATITUDE LONGITUDE <br /> Local Permit Agency EnvirnnmPntal Health <br /> Permit No. wp0038171 Permit Date 4/18/2018 APNlTRSf0THER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) –+L VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Moormans Water Systems <br /> DRILLING <br /> DEPTH FROM METHOD ROTARY FLUID g <br /> Mailin Address 2120 Wilcox Rd <br /> SURFACEDESCRIPTION Stockton CA 95215 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY �y STATE ZIP <br /> 0 3 To Soil Address 2723 N.Alpine ffLL LOCATION <br /> 3 50 Clav Cin,Stockton CA <br /> 50 55 Sand <br /> 55 60 Clay County San,loaquin <br /> APN Book Page Parcel <br /> 60 66 Sand Township Range Section <br /> 66 115 Clay Latitude 1 1 1 <br /> 115 126 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 126 171 Clay LOCATION SKETCH ACTIVITY (✓) <br /> NORTH N/ NEW WELL <br /> 171 189 Sand <br /> 189 228 Clay MODIFICATION/REPAIR <br /> --Deepen <br /> 228 233 Sand —Other(Specify) <br /> 233 243 Clay <br /> 243 245 Sand — DESTROY (Describe <br /> Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> 245 256 Clay PLANNED USES(4) <br /> 256 257 Sand WATER SUPPLY <br /> 257 292 Clay vU) y Domestic— Pubic <br /> 292 294 Sand C Irrigation _ Industrial <br /> 294 307 Clay MONITORING— <br /> TEST WELL— <br /> 307 318 Shale ATHODIC PROTECTION- <br /> 318 327 Clay HEAT EXCHANGE- <br /> 327 328 Sand DIRECT PUSH- <br /> 328 364 Clay INJECTION_ <br /> VAPOR EXTRACTION— <br /> 364 365 Sand SPARGING_ <br /> 365 400 Shale roSOUTH 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 /> necessary. 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 109 (Ft.)&DATE MEASURED 4/25/2018 <br /> TOTAL DEPTH OF BORING 400 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 300 (Feet) I May not be representative o a well's lon -term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE FROM SURFACE p <br /> DIA. y W W MATERIAL/ INTERNAL GAUGE SLOT SIZE <br /> CE- BEN- <br /> Ft. to Ft. (Inches) g tr g j GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> m L) V LL (Inches) THICKNESS (Inches) Ft. to Ft. (� ✓ (TYPE/SIZE) <br /> 0 170 14 <br /> 170 210 V <br /> -045 100 '� GRAVEL <br /> 210 220 <br /> 220 260 <br /> 260 280 <br /> 280 300 ✓ <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 M,OR CORPORATION) (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 Albers Rd',, Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF ITDCISTS. Signed 05/09/18 668622 <br /> 11 WELL DRILLER/AUTHOR12it REPRESENTATIVE DATE SIGNED C57 LICENSE NUMBER <br /> DWR 198 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />