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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY - DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT I I I I I l l 1 1 l l <br /> Page I of I Refer to Instruction Pamphlet STATE WELL NO.I STATION NO. <br /> Owner's Well No. 95215 No-e0366510 I I I❑ <br /> Date Work Began 5/23/2018 Ended5/24/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Fnvirnnmental Health I i I I I I I I I I I <br /> Permit No. wp0038231 Permit Date 5/9/2018 APNrrRSIOTHER <br /> GEOLOGIC LOG NVE1,L OWNER <br /> ORIENTATION(✓) -,e-VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Moormans Water Systems <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 2120 Wilcox Rd <br /> DESCRIPTION Stockton CA 95215 <br /> Ft. to Ft. Describe material grain, size, color, etc. CIN STATE ZIP <br /> 0 4 Top Soil Address 5272 N. BoggianolF��"LOCATIO <br /> 4 18 Clay City Stockton CA 95215 <br /> 18 28 Sand County San Joaquin _ <br /> 28 55 Clay APN Book Page Parcel <br /> 55 63 Sand <br /> 63 100 Clay Township Range Section _ <br /> Latitude I I <br /> 100 103 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 103 108 Clay LOCATION SKETCH ACTIVITY (✓) <br /> 108 118 Sand NORTH -/ NEW WELL <br /> 118 126 ClayMODIFICATION/REPAIR <br /> —Deepen <br /> 126 130 Sand —other(specify) <br /> 130 138 Clay <br /> 138 171 Sand — DESTROY <br /> a0nd Materials <br /> Under"GEOLOGIC LOG' <br /> 171 278 Clay PLANNED USES(z) <br /> 278 322 Shale WATER SUPPLY <br /> 322 337 Sand w ; Domestic— Public <br /> 337 358 Shale ui Irrigation _ Industrial <br /> 358 360 Sand MONITORING— <br /> TEST WELL— <br /> 360 366 Shale <br /> ATHODIC PROTECTION- <br /> 366 367 Sand HEAT EXCHANGE- <br /> 367 398 Shale DIRECT PUSH__ <br /> 398 413 Sand INJECTION— <br /> VAPOR EXTRACTION_— <br /> 413 445 Shale SPARGING__ <br /> SOUTH 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 124 (Ft.)&DATE MEASURED 5/24/2018 <br /> TOTAL DEPTH OF BORING 445 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 420 (Feet) May not be representative o a well's lon -term yield <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE aTYPE _K' FROM SURFACE TYpDIA. MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) GRADE DIAMETER OR WALL IF ANY MENT TONT FILLFILTER PACK <br /> Ft to FL (Inches) THICKNESS (Inches) Ft to Ft. ✓ ✓ ✓ (TYPE/SIZE) <br /> to (_1 U _ <br /> 0 320 18 <br /> 320 340 .045 56 L <br /> 340 380 <br /> 380 420 <br /> ATTACHMENTS Is( 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,`f1R,CORPORATI- (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 Albers Rd - Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IFITEXISTS. Signed 05/30/18 668622 <br /> 11 WELL DRILLERIAUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR I&$REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />