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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 1mrruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95366 NO.e0351662 <br /> Date Work Began 8/28/2017 Ended8/29/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental RPsourePs <br /> Permit No. wp0037142 Permit Date 8/21/2017 APN/rRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(�) �-VERTICAL _HORIZONTAL —ANGLE —(SPECIFY) Name Don Ney <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 20843 Carrolton Rd <br /> DESCRIPTION Ripon CA 95366 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 2 Top Soil Address <br /> 17 Sand Address 20843 S Carrolton �'LOCATION <br /> City Ripon CA 95366 <br /> 17 30 Clay County San Joaquin <br /> 30 381 Sand APN Book Page Parcel <br /> 38 113 Clay Township Range Section <br /> 113 128 Sand Latitude l 1 <br /> 128 163 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 163 165 Sand LOCATION SKETCH ACTIVITY (✓ <br /> 165 184 Clay <br /> NORTH V NEW WELL <br /> SEP 18 <br /> 184 192 1 Sand - MODIFICATION/REPAIR <br /> —Deepen <br /> 192 210 Clay EWRONMEWAL —other(Specify) <br /> 210 212 Sand <br /> DESTROY(Describe <br /> 212 218 Clay Procedures and— Materials <br /> Under"GEOLOGIC LOG' <br /> 218 221 Sand PLANNED USES() <br /> 221 223 Clay WATER SUPPLY <br /> 223 225 Sand � ; Domestic— Public <br /> LIJ <br /> 225 231 Clay — Irrigation — Industrial <br /> 231 232 Sand MONITORING <br /> TEST WELL <br /> 232 265 Clay ATHODIC PROTECTION_ <br /> HEAT EXCHANGE— <br /> DIRECT PUSH— <br /> INJECTION <br /> VAPOR EXTRACTION <br /> SPARGING— <br /> SOUTH REMEDIATION— <br /> Ulu,i ure ur DescriAe 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 STATIC <br /> WATER LEVEL 48 (Ft.)&DATE MEASURED 8/29/2017 <br /> TOTAL DEPTH OF BORING 265 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 230 (Feet) May not be representative of a well's lon -term vield. <br /> DEPTH CASING(S) ANNULAR MATERIAL <br /> FROM SURFACE BORE- TYPE s DEPTH <br /> HOLE > FROM SURFACE TYPE <br /> DiA• Y W a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. to Ft. (Inches) g Lu 0 aJ GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> rn LL (Inches) THICKNESS (Inches) Ft. to Ft. (TYPE/SIZE) <br /> `0 (2�) L) <br /> 0 210 12 <br /> 210 230 `� RAVEL <br /> ATTACHMENTS (4) 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 MASE IS DRILLIN NC <br /> Geophysical Log(s) (PERSON, 1 I ED) <br /> — SoillWater Chemical Analysis 1 Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF/T EXISTS. Signed 09/05/17 668622 <br /> 11 WELL DRILLER/AUTHO D REPR ENTATI E DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.I1-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />