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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 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95367 NO.e0352918 <br /> Date Work Began 9/12/2017 , Ended9/13/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I I I I I 1 1_ <br /> Permit No. wp0037075Permit Date 8/14/2017 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Fidel Yipez <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 6037 Deep River Ct <br /> DESCRIPTION Riverbank CA 95367 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 18105 S Seid WFEldt"L LOCATION <br /> 3 7 Hard Pan City Escalon CA 95320 <br /> 7 18 Sand <br /> 18 22 Clay CountySan Joaquin <br /> APN Book Page Parcel <br /> 22 28 Sand <br /> 28 82 Clay Township Range Section <br /> 82 95 Sand and Gravel Latitude DEG. I MIN. I SEC. DEG. I MIN. , SEC. <br /> 95 114 Clay LOCATION SKETCH ACTIVITY (✓) <br /> NORTH 10" NEW WELL <br /> 114 120 Gravel <br /> FICATION/REPAIR <br /> MODI <br /> 120 223 Clay —Deepen <br /> 223 228 Sand —Other(Specify) <br /> 228 231 Clay <br /> — <br /> DESTROY (Describe <br /> 231 240 Black-Brown Sand Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> 240 269 Clay PLANNED USES() <br /> 269 274 Black-Brown Sand WATER SUPPLY <br /> 274 300 Clay N --,Z Domestic— Public <br /> Irrigation _ Industrial <br /> uJ 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&_ <br /> WATER LEVEL 93(Ft.)&DATE MEASURED 9/13/2017 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 300 (Feet) TEST LENGTH (Hrs-) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL280 (Feet) I May not be representative o a well's long-term Yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE MTYPE .!� FROM SURFACE TYPEDIA. MATERIAL/ INTERNAL GAUGE SLOT SIZECE- BEN- <br /> Ft to Ft (Inches) GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> (Inches) THICKNESS (Inches) Ft to Ft. ✓ (� �) (TYPE/SIZE) <br /> 0 260 105/8 PLASTIC 6 200 0 108 <br /> 260 280 .045 1 ....GRAVEL <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> — Geologic Log 1.the undersigned,certify that this report is complete and accurate to the best of my knovAedge and belief. <br /> — Well Construction Diagram NAME MASELLIS DRILLING INC <br /> — Geophysical Log(s) (PERSON,FIRM OR CORPORAT ) (TYPED R PRINT1fD) <br /> a <br /> — Soil/Water Chemical Analysis , A 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. I Signed 09/20/17 668622 <br /> WELL DRILLOR1Z PRESE ATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXTCONSEC LY NUMBERED FORM <br />