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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL, COMPLETION REPORT V I I <br /> � IIIII <br /> Page 1 of I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95320 NO.e0368065 I I I 1=1 ❑ <br /> Date Work Began 72018 Ended7/9/2018_ LATITUDE LONGITUDE <br /> Local Pemtit Agency Environmental Health I I I I I I I I I I I I L <br /> Permit No. wp0038421 Permit Date 6/13/2018 APWTRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(_�L) VERTICAL _HORIZONTAL —ANGLE —(SPECIFY) Name Glen Tavares <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 16452 Henry Rd <br /> SURFACEDESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material, grata, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 16452 Henry RcrELL LOCATION <br /> 3 15 Sand City Escalon CA 95320 <br /> 15 40 Shale CountySan Joaquin <br /> 40 65 Sand APN Book Page Parcel <br /> 65 120 Clay Township Range Section <br /> 120 128 Shale Latitude I I <br /> 128 130 Sand DEG. MIN. SEC. DEG. MIN. SEC, <br /> 130 208 Shale LOCATION SKETCH ACTMTY �✓i <br /> NORTH --I(— NEW WELL <br /> 208 210 Sand MODIFICATION/REPAIR <br /> 210 230 Shale —Deepen <br /> 230 233 Sand —Other(Specify) <br /> 233 264 Shale <br /> DESTROY(Describe <br /> 164 265 Sand Under res and"GEOLOGIC 265 283 Shale PLANNED USES() <br /> 283 285 Sand WATER SUPPLY <br /> _-Z Domestic— Public <br /> LU W <br /> Irrigation — Industrial <br /> LLl MONITORING— <br /> TEST WELL <br /> THODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH__ <br /> INJECTION— <br /> VAPOR EXTRACTION— <br /> SPARGING— <br /> SOUTH REMEDIATION— <br /> Illustnue or Describe Distance of Welt from Roads, Buildings, <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)— <br /> necessary.PLEASE BE ACCURATE & COMIPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STATIC <br /> WATER LEVEL 100 (Ft.)&DATE MEASURED 7/9/2018 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 285 (Feet) TEST LENGTH <br /> (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 250 (Feet) Mav not be representative o a well's Ion -term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE OLE IT�E FROM SURFACE TYPE <br /> DIA. MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) GRADE DIAMETER OR WALL IF ANY MENT TONT FILLFILTER PACK <br /> Ft. to Ft. (Inches) THICKNESS (Inches) Ft. to Ft (✓) U (TYPE/SIZE) <br /> 0 210 11 PLASTIC 6 200 0 100 <br /> 210 250 .045 100 250 � 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,F,.tRM,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 D(ISTS. Signed 07/11/18 668622 <br /> WELL DRILLER/AUTHOR_ REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />