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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 Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95355 No.e0358363 <br /> Date Work Began 11/29/2017 , Ended 11/30/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Hgalth _ I I I I I I I I I I I I <br /> Permit No. wp0037538 Permit Date 10/31/2017 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL _HORIZONTAL — ANGLE —(SPECIFY) Name Melissa Marques <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 3200 Allan Adele _ <br /> SURFACEDESCRIPTION Modesto CA 95355 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top SoilELL LOCATION <br /> 3 11 Sand Address 24220 Austin R <br /> City Ripon CA 95366 <br /> 11 25 Clay <br /> 25 27 Sand CountySan Joaquin <br /> APN Book Page Parcel <br /> 27 37 Clay Township Range Section <br /> 37 39 Sand Latitude I 1 1 <br /> 39 52 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 52 56 Gravel LOCATION SKETCH ACTIVITY (✓) <br /> 56 83 Clay NORTH V NEW WELL <br /> MODIFICATION/REPAIR <br /> 83 105 Sand —Deepen <br /> 105 112 Clay —Other(Specify) <br /> 112 123 Sand <br /> — DESTROY (Describe <br /> 123 134 Clay Procedures and Materials <br /> Under"GEOLOGIC LOG" <br /> 134 137 Sand PLANNED USES(.c) <br /> 137 156 Clay WATER SUPPLY <br /> 156 163 Sandr~n ; __Z Domestic— Public <br /> 174 184 Sand �$ Irrigation Industrial <br /> 184 238 Clay MONITORING— <br /> TEST WELL- <br /> 238 248 Blue Clay ATHODIC PROTECTION- <br /> 248 258 Brown Sand HEAT EXCHANGE- <br /> 258 270 Brown Clay DIRECT PUSH__ <br /> 270 272 Sand INJECTION <br /> 272 275 Clay VAPOR EXTRACTION— <br /> SPARGING <br /> 275 283 Sand SOUTH REMEDIATION— <br /> Illustrate or Describe Distance of Well from Roads, Buildings, <br /> 283 286 Clay Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)- <br /> 286 295 Sand necessary.PLEASE BE ACCURATE & COMPLETE. <br /> 295 310 Clay WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER- (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STATIC 11/30/2017 <br /> WATER LEVEL 8 (Ft.)&DATE MEASURED <br /> TOTAL DEPTH OF BORING 31 O ESTIMATED YIELD • (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 295 (Feet) Mav not be representative of a well's lon -term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE aE _-K FROM SURFACE TYPE <br /> DIA• MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. to Ft, (Inches) GRADE DIAMETER OR WALL IF ANY MENT TONY FILLFILTER PACK <br /> (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) �) (TYPE/SIZE) <br /> 0 275 12 <br /> 275 295 VEL <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, CORPORATIO (TYPFeD OR RINTED): <br /> — SoillWater Chemical Analysis 11 Al l 7 <br /> Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 1 12/01/17 668622 <br /> WELL DRILLER/AUTHORIZED%EPAESENTI#IVE F DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />