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QUADRUPLICATE STATE OF CALIFORNIADWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page I of I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95366 NO.e0367535 I I 1 1:1111 1 1 1 ❑ <br /> Date Work Began 6/19/2018 Ended LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Resources I I I I I I I I I I I I I <br /> Permit No.X0038420 Permit Date 6/13/2018 APNIFRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) V VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Brett McIntosh <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 1333 WAth St. <br /> DESCRIPTION Ripon CA 95366 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 01 2 Top Soil Address 23811 S.Jacktone LOCATIO <br /> 2 20 Clay City Ripon CA 95366 <br /> 20 23 Sand County San Joaquin <br /> 23 53 Clay APN Book Page Parcel <br /> 53 58 Sand Township Range Section <br /> 58 98 Clay Latitude I I I <br /> 98 108 Sand DEG. MIN. SEC. DEG, MIN. SEC. <br /> 108 113 Clay LOCATION SKETCH ACTIVITY (✓) <br /> 113 118 Sand NORTH --,(— NEW WELL <br /> 118 135 Clay MODIFICATIIDeepen <br /> WRnPAIR <br /> e <br /> 135 137 Sand —other(Specify) <br /> 137 168 Clay DESTROY <br /> 168 178 Sand Procedures escribe aDnd Materials <br /> Under"GEOLOGIC LOG' <br /> 178 218 Clay PLANNED USES(Z) <br /> 218 222 Sand WATER SUPPLY <br /> 222 255 Clay ~ h � Domestic — Public <br /> N Industrial <br /> 3 — Irrigation — <br /> 255 257 Sand MONITORING— <br /> 257 262 Clay TEST WELL- <br /> 262 264 Sand ATHODIC PROTECTION- <br /> 264 303 Clay HEAT EXCHANGE- <br /> 303 305 Sand DIRECT PUSH_ <br /> 305 325 Clay 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 (FL)BELOW SURFACE <br /> DEPTH LEVSTAT C$ <br /> WATER LE6/20/2018 <br /> EL (Ft.)&DATE MEASURED <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE _ <br /> TOTAL DEPTH OF BORING 325 (Feet) TEST LENGTH <br /> (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 312 (Feet) May not be representative o a well's lon -term yield <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE OLE TYPE ✓) FROM SURFACE TYPE <br /> DIA. y TY. <br /> a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z W o a GRADE DIAMETER OR WALL IF ANY FILTER PACK <br /> MENT TONI FILL <br /> Ft. to Ft. m L) o (Inches) THICKNESS (Inches) Ft. to Ft. (TYPEISIZE) <br /> m a ✓ (�) (✓) <br /> 0 292 12 <br /> 292 312 .045 205 312V/ <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,FIRIA,,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 EXISTS. 11 fined 06/21/18 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 />