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QUADRUPLICATE STATE OF CALIFORNIADWR 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. 95366 No.e0352922 <br /> Date Work Began 9/15/2017 Ended9/15/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Hpalth ___.1 I I I I I I I I I I I L_ <br /> Permit No. wp0037298 Permit Date 9/11/2017 APN/rRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL _HORIZONTAL —ANGLE —(SPECIFY) Name Rick Hogan <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud ailing Address P.O. BOX 807 CA 95366 <br /> SURFACEDESCRIPTION <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 2 Top SoilAddress 20021 S JackToneLOCATIO <br /> 2 24 Sand City Ripon CA 95366 <br /> 24 43 Clay <br /> CountySan Joaquin <br /> 43 58 Sand <br /> APN Book Page Parcel <br /> 58 68 Clay <br /> 68 73 Sand Township Range Section <br /> Latitude I I 1 , <br /> 73 118 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 118 134 Sand LOCATION SKETCH ACTIVITY (✓) <br /> NORTH --I/— NEW WELL <br /> 134 158 Clay <br /> 158 1631 Sand MODIFICATION/REPAIR <br /> —Deepen <br /> 163 208 Clay —other(Specify) <br /> 208 213 Sand <br /> — DESTROY(Describe <br /> 213 236 Clay Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> 236 238 Sand PLANNED USES(Z) <br /> 238 277 Clay WATER SUPPLY <br /> 277 283 Sand c ; _-Z Domestic— Pubic <br /> LU <br /> 283 296 Clay — Irrigation _ Industrial <br /> 296 301 Sand MONITORING— <br /> TEST WELL- <br /> 301 305 Clay 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 QV (Ft)&DATE MEASURED 9/15/2017 <br /> TOTAL DEPTH OF BORING 305 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN <br /> (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 290 (Feet) May not be representative o a well's long-term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE FROM SURFACE NPE <br /> DIA. x w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z O GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> Ft. to Ft. m v LL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ ✓ (TYPE/SIZE) <br /> 0 270 12 <br /> 270 290 .045 200 <br /> ATTACHMENTS (r ) CERTIFICATION STATEMENT <br /> — Geologic Log I,the undersigned,certify that this report is complete and accurate to the beat of my knowledge and belief. <br /> Well Construction Diagram NAME MASELLIS DRILLING INC <br /> — Geophysical Log(s) (PERSON,FIRM,OR CORPORATION) (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 AlbersRd&'%, 7 Modesto CA 95357 <br /> — Other ADDRESSCITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 1 09/20/17 668622 <br /> WELL D A TATtVE DATE SIGNED C57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />