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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page I of 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95215 No.e0367524 I i I DOI ❑ <br /> Date Work Began 5/29/2018 Ended5/30/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I I I I I I I (— <br /> Permit No. wP0038321 Permit Date 5/22/2018 APNrrRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) v/ VERTICAL —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 /> Ft. to Ft. Describe material grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 9009 S. Grove T&ee1LnLOCATiO <br /> 3 12 Sand City French Camp CA 95231 <br /> 12 22 Clay County San Joaquin <br /> 22 26 Sand APN Book Page Parcel <br /> 26 33 Clay Township Range Section <br /> 33 40 Sand Latitude I <br /> 40 66 Soft Caly DEG. MIN. SEC. DEG. MIN. SEC. <br /> 66 76 Sand LOCATION SKETCH ACTIVITY V) <br /> 76 118 Clay NORTH I/ NEW WELL <br /> MODIFICATION/REPAIR <br /> 118 130 Sand —Deepen <br /> 130 146 Clay —Other(Specify) <br /> 146 149 Sand <br /> 149 153 Clay — DESTROY <br /> (Describe <br /> and Materials <br /> Under"GEOLOGIC LOG' <br /> 153 165 Sand PLANNED USES() <br /> 165 168 Clay WATER SUPPLY <br /> 168 171 Sand a) ; Domestic_ Public <br /> 171 190 Clay Irrigation — Industrial <br /> MONITORING— <br /> TEST WELL <br /> — <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 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 1 <br /> DEPTH OF STAT C5/30/2018 <br /> WATER LEVEL 8 (Ft.)&DATE MEASURED <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 190 (FeeL) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 175 (Feet) M not be representative o a well's loo -term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓) FROM SURFACE TYPE <br /> DLA. Y Z a MATERIAL/ INTERNAL GAUGE SLOT SIZE <br /> CE- BEN- <br /> (inches) Z o aJ GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> Ft. to Ft. m v LL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) �) (TYPE/SIZE) <br /> 0 155 12 PLA TIC 6 900 0 106 <br /> 155 175 106 1 '� GRAVEL <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> — Geologic Log 1,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 CORPORATI@S (TYPED OR PRINTED) <br /> — Soilrwater Chemical Analysis 119 Albers Rd Modesto CA 95357 _ <br /> a u CITY <br /> — Other ADDRESS STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IFITEXISTS. Signed 06/05/18 668622 <br /> WELL DRILLER/AUTHORIZE PRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 189 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />