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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. 95366 No-e0367534 1111 IDDI ❑ <br /> Date Work Began 6/14/2018 Ended6/15/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Enviommental Health -1--!__1 - <br /> Permit No. wp0038346 Permit Date 5/29/2018 APN/rRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -,e-VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Marlene Coonce <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address P.O. BOX 660 <br /> SURFACEDESCRWnON Ripon CA 95366 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 2 Top SoilAddress 10877 S.Jacktone LOCATIO <br /> 2 65 Clay City Stockton CA <br /> 65 83 Sand ColmtySan Joaquin <br /> 83 107 Clay <br /> 107 128 Sand APN Book Page Parcel <br /> Township Range Section <br /> 128 1431 Clay Latitude I 1 1 <br /> 143 151 Sand and Gravel DEG. MIN. SEC. DEG. MIN. SEC. <br /> 151 167 Clay LOCATION SKETCH ACTIVITY (V) <br /> NORTH Z NEW WELL <br /> 167 173 Sand MODIFICATION/REPAIR <br /> 173 322 Clay —Deepen <br /> 322 324 Sand —other(Specify) <br /> 324 330 Shale <br /> 330 342 Sand <br /> DESTROY <br /> a0nd Materials <br /> Under"GEOLOGIC LOG" <br /> 342 370 Shale PLANNED USES() <br /> WATER SUPPLY <br /> WN --ZDomestic— PutAic <br /> Q Irrigation — Industrial <br /> uI MONITORING— <br /> TEST WELL— <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH_ <br /> INJECTION—_ <br /> VAPOR EXTRACTION— <br /> SPARGING_ <br /> — <br /> /llustmte or DescribSOUTH REMEDIATION <br /> e Distance of(Nell 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 C <br /> WATER LEVEL- (Ft.)&DATE MEASURED 6/15/2018 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 370 (Feet) TEST LENGTH <br /> TOTAL DEPTH OF COMPLETED WELL 350 (His.) TOTAL DRAWDOWN (Ft) <br /> (F�) Mav not be representative o a well's long-term vield <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE 1;��PE ✓) FROM SURFACE TYPE <br /> DA. MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN(Inches) w pa GRADE DIAMETER OR WALL IF ANY MENT T E FILL FILTER PACK <br /> Ft to Ft N v a (Inches) THICKNESS (Inches) Ft. to Ft (�) U (TYPE/SIZE) <br /> 0 330 12 PLASTIC 6 900 0 108 <br /> 330 350 .045 108 350 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 /> — Soil/Water Chemical Analysis 119 Albers Rd Modesto CA 95357 <br /> Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT DCISTS. Signed 06/19/18 668622 <br /> WELL DRILLER/AUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />