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QUADRUPLICATE STATE OF CALIFORNIA i USE ONLY —DO NO FILL IN <br /> For Local Requirements WELL COMPLETION REPORT F—i <br /> Page I of I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95215 No-e03161489 <br /> Date Work Began 1/2/2018 Endedl/3/2018 LATITUDE LONGITUDE <br /> Local Permit Agency EnvironmAntal Health I I I I I I I I I I I I I I� <br /> Permit No. wp0037730 Permit Date 12/262017 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION VERTICAL —HORIZONTAL — ANGLE —(SPECIFY) Name Moormans 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 Soil Address 6052 E Eight MAP"LOCATIO <br /> 2 33 Clay City Stockton CA 95212 <br /> 33 45 Sand County San Joaquin <br /> 45 88 Clay <br /> 88 93 Sand APN Book Page Parcel <br /> 93 133 Clay Township Range Section _ <br /> Latitude I 1 1 <br /> 133 160 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 160 1881 Clay LOCATION SKETCH— ACTIVITY (✓) <br /> NORTH —V--' NEW WELL <br /> 188 192 Sand MODIFICATION/REPAIR <br /> 192 201 Clay —Deepen <br /> 201 204 Sand —Other(Specify) <br /> 204 308 Clay <br /> — DESTROY (Describe <br /> 308 315 Sand Under ures and <br /> Materials <br /> IC LOG" <br /> 315 332 Clay PLANNED USES(.) <br /> 332 342 Coarse Sand WATER SUPPLY <br /> 342 380 Clay <br /> ~ --I( Domestic— Public <br /> Irrigation Industrial <br /> 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 Weli from Roads, Buildings, <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)_ <br /> neeemry.PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> DEPTH OF STATJC <br /> WATER LEVEL A`g(Ft.)&DATE MEASURED 1/3/2018 <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 380 (Feet) TEST LENGTH <br /> (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 348 (Feet) Mav not be representative of a well's lon -term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE aTYPE .!L) FROM SURFACE pDIA. MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft, to Ft. (Inches) THICKNESS (Inches) Ft. to Ft. (✓) L) (TYPE/SIZE) <br /> 0 328 14 <br /> 328 348 '� GRAVEL <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> — Geologic, Log 1,the undersigned,certify that this report is complete and accurate to the best of my knoWedge and belief. <br /> Well Construction Diagram NAME MASELLIS DRILLING INC <br /> — Geophysical Log(s) (PERSON,FIRA,OR CORPORATIJI) (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 Albers Rd Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACHADDITIONALINFORMATION,IFITIXISTS. Signed 01/18/18 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 />