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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. 95204 No.e0338064 ❑I I I I I 1 ❑ <br /> Date Work Began 3/14/2017 Ended3/15/2017 LATITUDE LONGITUDE <br /> Local Permit Agency FnvirnnmPntal Health <br /> Permit No. 76364 Permit Date 12/5/2016 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION VERTICAL —HORIZONTAL — ANGLE —(SPECIFY) Name Thomas Sousa <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Stockton Mailing Address P.O. BOX 4487 CA 95204 <br /> SURFACEDESCRIPTION <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top SoilWELL LOCATION <br /> 3 13 Clay Address 2240 W.White Ln <br /> 13 17 Sand City Stockton CA <br /> 17 22 Clay County San Joaquin <br /> APN Book Page Parcel <br /> 22 29 Sand Township Range Section <br /> 29 108 Clay Latitude t I <br /> 108 118 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 118 162 Clay LOCATION SKETCH ACTIVITY Lv) <br /> NORTH -' NEW WELL <br /> 162 165 Sand MODIFICATION/REPAIR <br /> 165 172 Clay —Deepen <br /> 172 183 Sand —other(Specify) <br /> 183 238 Clay <br /> 238 240 Sand DESTROY <br /> a0nd Materials <br /> 240 246 Clay Under"GEOLOGIC LOG <br /> PLANNED USES() <br /> 246 250 Sand WATER SUPPLY <br /> Domestic— Public <br /> 250 272 Clay N <br /> 272 273 Sand <br /> LU Irrigation Industrial <br /> 273 278 Clay MONITORING— <br /> TEST WELL_ <br /> 278 282 Sand THODIC PROTECTION- <br /> 282 308 Clay HEAT EXCHANGE- <br /> 308 313 Sand DIRECT PUSH_ <br /> 313 326 Clay INJECTION— <br /> VAPOR EXTRACTION— <br /> 326 333 Sand <br /> SPARGING— <br /> 333 335 Clay SOUTH REMEDIATION— <br /> /llusirate or Describe Distance of Well from Roads, Buildings, <br /> 335 345 Sand 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 <br /> DEPTH OF STAT C <br /> WATER LEVEL- (Ft.)&DATE MEASURED 3/15/2017 <br /> TOTAL DEPTH OF BORING 345 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 350 (Feet) M not be representative o a well's lon -term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓) FROM SURFACE TYPE <br /> DIA. Y w z a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft, to Ft. (Inches) g v a GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> m y � (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓� �) (TYPEISIZE) <br /> 0 305 14 <br /> 305 350 0 GRAVEL <br /> ATTACHMENTS 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,FIR R CORPC) ) (TYPED PRINTF) <br /> — Soll/Water Chemical Analysis 19 AI e <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 03/22/17 6686)22 <br /> WELL DRILLER/AUTHO IZ PRESE ATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.I1-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECITIVELY NUMBERED FORM <br />