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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 I Refer to Instruction Pamphle/ STATE WELL NO./STATION NO. <br /> Owner's Well No. 95215 No-e0367529 11 1 1 1 11111 ❑ <br /> Date Work Began 6/6/2018 Ended6/7/2018 LATITUDE LONGITUDE <br /> Local Permit Agency EnvimrimPntal Health 1 1 1 1 1 1 1 1 1 1 1 1 I_ <br /> Permit No. wp0038349 Permit Date 5/29/2018 APNrrRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Moorman's 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. CITY STATE ZIP <br /> 0 2 Top SoilEL OCATIO <br /> 2 13 Sand Address 792 W. Woodbri ge <br /> City Lodi CA 95242 <br /> 13 73 Clay <br /> 73 83 Sand CountySan Joaquin <br /> APN Book Page Parcel <br /> 83 167 Clay Township Range Section <br /> 167 168 Sand Latitude I 1 <br /> 168 180 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 180 181 Sand LOCATION SKETCH ACTIVITY �) <br /> 181 192 Clay NORTH NEW WELL <br /> 192 193 Sand MODIFICATION/REPAIR <br /> —Deepen <br /> 193 198 Clay —Other(Specify) <br /> 198 210 Sand <br /> DESTROY (Describe <br /> 210 235 Blue Clay Procedures and Materials <br /> Under"GEOLOGIC LOG" <br /> PLANNED USES() <br /> WATER SUPPLY <br /> ~ __%K Domestic— Public <br /> CO <br /> Q Irrigation _ Industrial <br /> u1 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 /> /llustmte 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 <br /> WATER LEVEL- 8 (Ft.)&DATE MEASURED 6/7/2018 <br /> TOTAL DEPTH OF BORING 235 ESTIMATED YIELD • (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN <br /> (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL220 (Feet) May not be representative of a well's lon -term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓) FROM SURFACE TYPE <br /> DIA. y Z a MATERIAL I INTERNAL GAUGE SLOT SIZECE- BEN <br /> (Inches) Z p aJ GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft. to Ft. 0 U LL (Inches) THICKNESS (Inches) Ft. to Ft ✓ (✓) �) (rYPEISIZE) <br /> 0 200 12 <br /> 200 220 .045 108 220 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,OR CORPORATf?N) (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 EXISTS. Signed "� 06/15/18 668622 <br /> WELL DRILLER/AUTHORIZED,REPRESENTATIVE I DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 189 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />