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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REI'ORT <br /> Page 1 of I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95320 NO.e0339657 ❑ ❑ <br /> Date Work Began 4/6/2017 Ended4/18/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I I I I I I I I I I <br /> 76939 3/10/2017 APN/TRS/OTHER <br /> Permit No. Permit Date <br /> GEOLOGIC LOG WELL OWNER — <br /> ORIENTATION(✓) -�VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Joan Lewis Trust <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 14241 Campbell Rd <br /> SURFACEDESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 27 Sand Address 17241Campbell� 'L LOCATION <br /> ION <br /> 27 54 ClayEsc Ion CA 95320 <br /> 54 65 Sand City <br /> CountySan Joaquin <br /> 65 68 Clay APN Book Page Parcel _ <br /> 68 71 Sand Township Range Section <br /> 71 84 Clay Latitude I I <br /> 84 87 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 87 106 Clay LOCATION SKETCH ACTTVITY (✓) <br /> 106 117 Sand and Gravel NORTH — --v'— NEW WELL <br /> 117 120 Clay MODIFICATIIO REPAIR <br /> 120 125 Sand and Gravel —Other(Specify) <br /> 125 132 Clay <br /> DESTROY(Describe <br /> 132 134 Gravel Procedures and Materials <br /> Under"GEOLOGIC LOG" <br /> 134 142 Clay PLANNED USES() <br /> 142 149 Sand and Gravel WATER SUPPLY <br /> 149 164 Clay w � Domestic— Public <br /> 164 177 Sand — Irrigation — Industrial <br /> 177 193 Clay MONITORING— <br /> TEST WELL— <br /> 193 200 Sand ATHODIC PROTECTION- <br /> 200 207 Shale HEAT EXCHANGE- <br /> 207 218 Clay DIRECT PUSH_ <br /> 218 224 Shale INJECTION— <br /> VAPOR EXTRACTION— <br /> 224 230 Clay <br /> SPARGING— <br /> 230 237 Sand SOUTH REMEDIATION— <br /> Illusimte or Describe Distance of Well from Roads, Buildings, <br /> 237 240 Clay Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)- <br /> 240 260 Shale neceaaary. PLEASE BE ACCURATE & COMPLETE. <br /> 260 266 Fine Sand WATER LEVEL&YIELD OF COMPLETED WELL <br /> 266 293 Shale DEPTH TO FIRST WATER (Ft.)BELOW SURFACE 1 <br /> 2931 300 Sand DEPTH OF STATbbC <br /> 300315 Shale WATER LEVEL V6 (Ft.)&DATE MEASURED 4/21/2017 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 315 (Feet) TEST LENGTH <br /> (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 305 (Feet) May not be representative of a well's Ion -term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL, <br /> FROM SURFACE BORE OLE TYPE ✓) FROM SURFACE TY E <br /> DIA. Y W o- MATERIAL/ INTERNAL GAUGE SLOT SIZE <br /> CE- BEN- <br /> (Inches) Z W p o GRADE DIAMETER OR WALL IF ANY MENT TONI FILL FILTER PACK <br /> Ft. to FL m N v (Inches) THICKNESS (Inches) Ft. to Ft. ✓ ✓ ✓ (TYPE/SIZE) <br /> (_) U <br /> 0 185 14 <br /> 185 205 v .045 50 305GRAVEL <br /> 205 225 <br /> 225 245 <br /> 245 285 <br /> 285 305 <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,FIRM CORPORATI (T�.EO P <br /> — SoillWater Chemical Analysis 19AlbRA1WI <br /> Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMA77ON,IF IT EXISTS. Signed 05/10/17 668622 <br /> 11 WELL DR ILLERIAUTHORIZEDVVRESENIVrIVE 7 DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />