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QUADRUPLICATE STATE OF CALIFORNIADWR USE ONLY — DO NOT FILL IN <br /> Vor Local Requirements WELL COMPLETION REPORT <br /> Page 1 of 2 Refer to Instruction Pamphlet STATE WELL N0./STATION NO. <br /> Owner's Well No. 95215 No.e0367539 I ❑ I I I I ❑ <br /> Date Work Began 6/22/2018 Ended6/25/2018 -_ LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health - I I I 1 I I 1 1 1 1 1 . <br /> Permit No. wp0038317 Permit Date 5/23/2018 APNITRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(IVERTICAL HORIZONTAL —ANGLE —(SPECIFY) Name Moormans Water Systems <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 2120 Wilcox Rd <br /> 'SURFACEDESCRIPTION Stockton CA 95215 <br /> FL to Ft. Describe material, grain, size, color, etc. CITE' STATE ZIP <br /> 0 2 Top SoilL LOCATIO <br /> Address 9800 E.Acampo�c�' <br /> 2 8 Sand Cit,Acampo CA <br /> 8 60 Clay County San Joaquin <br /> 60 65 Sand APN Book Page Parcel <br /> 65 145 Clay Township Range Section _ <br /> 145 147 Sand Latitude I 1 <br /> 147 155 Clay DEG. MIN, SEC. DEG. MIN. SEC. <br /> 155 156 Sand LOCATION SKETCH ACTIVITY (✓) <br /> Sand <br /> NORTH I/ NEW WELL <br /> 156 160 MODIFICATION/REPAIR <br /> 160 167 Sand —Deepen <br /> 167 176 Clay —other(Specify) <br /> 176 1801 Fine Sand <br /> — DESTROY(Describe <br /> 180 188 Clay Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> 188 190 Sand PLANNED USES(-L) <br /> 190 202 Blue Clay WATER SUPPLY <br /> 202 204 Blue Sand co y — Domestic_ Public <br /> 204 235 Blue Clay — Irrigation Industrial <br /> 235 248 Brown Clay MONITORING- <br /> 248 251 Brown Sand TEST WELL- <br /> - <br /> PROTECTION- <br /> 251 255 Brown Clay HEAT EXCHANGE- <br /> 255 280 Blue Clay 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 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 46 (Ft.)&DATE MEASURED 6/25/2018 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 280 (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 260 (Feet) May not be representative o a well's Ion——tern yield. <br /> DEPTH CASING(S) ANNULAR MATERIAL <br /> FROM SURFACE BORE- — - DEPTH <br /> HOLE TYPE _) FROM SURFACE TYPE <br /> DIA• Y w og MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. to Ft. (Inches) g oI Lu <br /> GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> m c� (Inches) THICKNESS (Inches) Ft to Ft. (TYPE/SIZE) <br /> 0 140 18 vi PLASTIC 10 200 0 56- <br /> 140 170 .045 56 260 GRAVEL <br /> 170 180 V PLASTIC 10 200 <br /> 180 220 .045 _ <br /> 220 240 V PLASTIC 10 200 <br /> 240 260 .045 <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,FIRM,-,GR 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 IT(JOISTS. fined 06/26/18 668622 <br /> 11 WELL DRILLER/AUTHORIZEE),,. PRESEN TATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />