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DUPLICATE STATE OF CALIFORNIA wR U E ONLY — D N T FILL I <br /> Drillees Copy WELL COMPLETION REPORT <br /> Page 1 of 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95215 No-e0338062 IDDL-1- 1 III <br /> Date Work Began 3/21/2017 Ended3/21/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Frivirnnmental Health _ _— <br /> Permit No. 76227 Permit Date 11/15/2016 APNrrRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) V VERTICAL _HORIZONTAL — ANGLE —(SPECIFY) Name Moormans Water Systems <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud MailinStockton Address 2120 Wilcox Rd CA 95215 <br /> SURFACEDESCRIPTION <br /> Ft. to Ft. Describe rltatertal, grain, size, color, etc. CITY STATE ZIP <br /> 0 2 Top Soil Address 11006 Hwy 120 WELL LOCATIO <br /> 2 17 Sand City Manteca CA <br /> 17 22 Clay County San Joaquin <br /> 22 28 Sand APN Book Page Parcel <br /> 28 67 Clay Township Range Section <br /> 67 86 Sand Latitude r I <br /> 86 216 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 216 223 Sand LOCATION SKETCH ACTIVITY (✓) <br /> 223 2331 Clay NORTH .-Ikl NEW WELL <br /> FICATIONIREPAIR <br /> MODI <br /> 233 238 Sand T Deepen <br /> 238 258 Clay —other(Specify) <br /> 258 261 Sand <br /> — DESTROY(Describe <br /> 261 266 Clay Procedures and Materials <br /> Under"GEOLOGIC LOG" <br /> 266 268 Sand PLANNED USES() <br /> 268 273 Clay WATER SUPPLY <br /> 273 274 Sandw Domestic— Public <br /> 274 278 Clay irrigation — Industrial <br /> — <br /> 278 283jSand MONITORING <br /> TEST WELL <br /> 283 295 Clay — <br /> THODIC 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 /> neeessary. 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 (Ft.)&DATE MEASURED 3/23/2017 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 295 (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 295 (Feet) M not be representative of a well's lon -term yield. <br /> DEPTHCASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE B�L E TYPE ✓ FROM SURFACE TYPE <br /> DIA. Y w a MATERIAL! INTERNAL GAUGE SLOT SIZE CE- I BEN- <br /> R. to Ft. (Inches) g p J GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> m U o LL (Inches) THICKNESS (Inches) Ft to Ft. ✓ (TYPE/SIZE) <br /> ✓ <br /> (—) U <br /> 0 275 12 <br /> 275 295 .045 200 295 � GRAVEL <br /> ATTACHMENTS (y) 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,O TIONnypi <br /> E4 1 <br /> — SoiVWater Chemical Analysis 1 Ode <br /> — Other ADDRESS V'MCITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT t7CISTS Signed 04/18/17 X8622 <br /> WELL DRILLERlAUTHORIZED R SENTA E DATE SIGNED C57 LICENSE NUMBER <br /> DWR 199 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />