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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 2 of 2 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95215 No.e0367539 1111 IDE1 111 170 <br /> Date Work Began 6/22/2018 Ended6/25/2018 LATITUDE LONGITUDE <br /> Local Permit Agency FnvironmPntal Health I I I I I I I I_ I _ <br /> Permit No. WP0038317 Permit Date 5/23/2018 APNrMS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL —HORIZONTAL — ANGLE —(SPECIFY) Name Moormans Water Systems <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 2120 Wilcox Rd <br /> SURFACE DESCRIPTION Stockton CA 9.5215 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 2 Top Soil Address 9800 E.AcampoyJL LOCATIO <br /> 2 8 Sand City Acampo CA <br /> 8 60Clay County San Joaquin <br /> 60 65 Sand <br /> 65 145 Clay APN Book Page Parcel <br /> Township Range Section <br /> 145 147' Sand Latitude I <br /> 147 155 ClayDEG. MIN. SEC. DEG. MIN. SEC. <br /> 155 156 Sand LOCATION SKETCH ACTIVITY �) <br /> Sand <br /> NORTH -IN" NEW WELL <br /> 156 160 MODIFICATION/REPAIR <br /> 160 167 Sand —Deepen <br /> 167 176 Clay —other(Specify) <br /> 176 180 Fine Sand <br /> 180 188 Clay _ DESTROY <br /> durres(Des <br /> Materials <br /> Under"GEOLOGIC LOG' <br /> 188 190 Sand PLANNED USES(-L) <br /> 190 202 Blue Clay WATER SUPPLY <br /> 202 204 Blue Sand N — Domestic— Pudic <br /> LU 204 235 Blue Clay L — Irrigation — Industrial <br /> 235 248 Brown Clay MONITORING— <br /> TEST WELL— <br /> 248 251 Brown Sand ATHODIC 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 STATIC6/25/2018 <br /> WATER LEVEL (Ft.)&DATE MEASURED <br /> TOTAL DEPTH OF BORING 280 ESTIMATED YIELD ` (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 260 (Feet) M not be representative of a well's long-term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓ FROM SURFACE TYPE <br /> DIA. y wa MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z Zp E GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft to Ft. m 0 v (Inches) THICKNESS (Inches) Fl. to Ft ✓ (✓) (TYPEISIZE) <br /> 0 56 <br /> 56 260 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 <br /> — Geophysical Log(s) (PERSON,FIRM,OR CORPORATION) (TYPED OR PRINTED) <br /> — Soit[Water Chemical Analysis 119 Albers R e Modesto CA 95357 <br /> Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EMSTS. Signed 06/26/18 668622 <br /> jI WELL DRILLERIAUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />