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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 I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95337 NO.e0368064 I ❑ I I ❑ <br /> Date Work Began 7/9/2018 Ended7/11/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health ` I I I I I I I h <br /> Permit No. wp0038507 Permit Date 7/3/2018 <br /> APN/rRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -'—' VERTICAL —HORIZONTAL ANGLE —(SPECIFY) Name Bob Agdoma <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 22523 S. Union Rd <br /> DESCRIPTION Manteca CA 95337 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY y STATE ZIP <br /> 0 2 Top Soil Address 22523 S. Union K(]LL LOCATIO <br /> 2 15 Sand City Manteca CA 95337 <br /> 15 35 Shale County San Joaquin <br /> 35 40 Clay APN Book Page Parcel <br /> 40 65 Sand Township Range Section _ <br /> 65 128 Clay Latitude I I <br /> 128 130 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 130 183 Shale LOCATION SKETCH ACTIVITY ) <br /> NORTH --3L NEW WELL <br /> 183 190 Sand <br /> 190 206 Clay MODIFICATION/REPAIR <br /> Deepen <br /> r <br /> 206 2161 Sand —other(Specify) <br /> 216 239 Clay <br /> — <br /> DESTROY(Desribe <br /> 239 240 Sand Procedures and cMaterials <br /> 240 255 Fine Sand Under"GEOLOGIC LOG <br /> PLANNED USES() <br /> 255 273 Sand WATER SUPPLY <br /> 273 274 Clay n ; --ZDomestic_ Public <br /> 274 280 Sand Irrigation _ Industrial <br /> 280 285 j Clay MONITORING— <br /> TEST WELL— <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�c <br /> WATER LEVEL- ,�—(Ft.)&DATE MEASURED 7/11/2018 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 285 (Feet) TEST LENGTH <br /> (Hrs.) TOTAL DRAWDOWN (FL) <br /> TOTAL DEPTH OF COMPLETED WELL 280 (Feet) May not be re resentadw of a well's lona-term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE aT�YPE —�vL) FROM SURFACE TYPE <br /> DIA. MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) GRADE DIAMETER OR WALL IF ANY MENT TONI FILL FILTERPACK <br /> Ft. to Ft. (Inches) THICKNESS (Inches) Ft. to Ft. (TYPE/SIZE) <br /> 0 260 11 <br /> 260 280 L <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 CORPORATI (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 Albers Rd ; 4. Modesto CA 95357 <br /> — Other ADDRESS CITYSTATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT DOSTS Signed 07/13/18 668622 <br /> WELL DRILLER/AUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 198 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />