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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-e0366507 III , =11- 11 I I ❑ <br /> Date Work Began 5/11/2018 Ended5/17/2018 LATITUDE LONGITUDE <br /> Local Permit Agency FnvironmPntal HPalth I I I I I I I I I I I I I <br /> Permit No. wp0038188 Permit Date 4/26/2018 APNIrRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) aL VERTICAL _HORIZONTAL —ANGLE —(SPECIFY) Name Moormans Water Systems <br /> DRILLING <br /> DEPTH FROM METHOD NARY FLUID Mud Mailing Address 2120 Wilcox Rd <br /> SURFACEDESCRIPTION Stockton CA 95215 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top SoilWELL LOCATIO <br /> Address 8445 Pezzi Rd <br /> 3 120 Clay City Stockton CA 95215 <br /> 120 133 Sand County San Joaquin <br /> 133 142 Clay APN Book Page Parcel <br /> 142 147 1 Sand Township Range Section <br /> 147 1801 Clay Latitude I 1 1 <br /> 180 1871 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 187 3381 Clay LOCATION SKETCH— ACTIVITY (✓) <br /> NORTH --V—" NEW WELL <br /> 338 340 Sand <br /> 340 345 ClayMODIFICATION/REPAIR <br /> —Deepen <br /> 345 350 Sand —other(Specify) <br /> 350 418 Clay <br /> — DESTROY(Describe <br /> 418 419 Sand Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> 419 569 Shale PLANNED USES(.,L) <br /> 569 580 Clay WATER SUPPLY <br /> 580 600 Shale U)) ►- Domestic— Public <br /> Q Irrigation _ Industrial <br /> ul MONITORING— <br /> TEST WELL <br /> ATHODIC PROTECTION_ <br /> HEAT EXCHANGE— <br /> DIRECT PUSH_ <br /> INJECTION— <br /> VAPOR EXTRACTION— <br /> SPARGING <br /> SOUTH REMEDIATION— <br /> Illustrate or Describe Distance of Well from Roads, Buildings, <br /> Fences,Rivers,etc. and attach a reap. 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 125 (FQ&DATE MEASURED 5/17/2018 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 600 (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 360 (Feet) May not be representative o a well's lon -term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE B ORE TYPE ✓) FROM SURFACE TYPE <br /> DIA. Y w a MATERIAL/ INTERNAL GAUGE SLOT SIZE <br /> CE- BEN- <br /> (Inches) w a GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> Ft. to Ft. m v LL (Inches) THICKNESS (Inches) Ft to Ft. ✓ (✓) U (TYPE/SIZE) <br /> 0 180 21 PLASTIC 12 9nn 0 56 <br /> 180 360 6 360 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 INC y <br /> Geophysical Log(s) (PERSON,FIRMCORPORATI (T1 P I INTED) <br /> Soil Water Chemical Analysis 119 AI Modesto CA 95357 <br /> Other ADDRESS CITY STATE ZIP <br /> Fr <br /> ATTACH ADDITIONAL INFORMATION,IFITEXISTS. Signed 05/22/18 668622 <br /> WELL DRILLER/AUTHORIZED PRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />