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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.t STATION NO. <br /> Owner's Well No. 95330 No.e0339668 <br /> Date Work Began 4/11/2017 Ended5/12/2017 _ LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health <br /> Permit No. 74833 Permit Date 5/10/2016 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) V VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) tName Del Osso Family Farms LLC <br /> DRILLING ROTARY <br /> DEPTHFLUIDMETHOD DESCRIPTION Mud Mailing Address 26 W.Stewart Rd <br /> Lathrop CA 95330 <br /> Ft. to FL Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 301 W. MantheyV�L LOCATIO <br /> 3 43 Sand Cit,Lathrop CA 95330 <br /> 43 65 Blue Clay County San Joaquin <br /> 65 90 Brown Clay APN Book Page Parcel <br /> 90 971 Sand Township Range Section <br /> 97 100 Clay Latitude i I i <br /> 100 106 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 106 117 Clay LOCATION SKETCH ACTIVITY ) <br /> NORTH _1b/ NEW WELL <br /> 117 120 Sand <br /> MODIFICATION/REPAIR <br /> MODI <br /> 120 130 Clay —Deepen <br /> 130 136 Sand —other(Specify) <br /> 136 142 Clay <br /> — DESTROY(Describe <br /> 142 198 Sand Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> 198 205 Clay PLANNED USES() <br /> WATER SUPPLY <br /> cn NDomestic— Pubic <br /> LIrrigation — Industrial <br /> MONITORING— <br /> TEST WELL <br /> — <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH— <br /> INJECTION— <br /> VAPOR EXTRACTION— <br /> SPARGING— <br /> SOUTH REMEDIATION— <br /> 111ustrote or Describe Distance of Weff 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 <br /> DEPTH OF STATIC <br /> WATER LEVEL _1 (Ft.)&DATE MEASURED 4/13/2017 <br /> TOTAL DEPTH OF BORING 205 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL200 (Feet) M not be representative o a well's Ion -term vield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE !) FROM SURFACE TYPE <br /> DIA. y w o. MATERIAL/ INTERNAL GAUGE SLOT SIZE <br /> (Inches) Z W 0 a GRADE DIAMETER OR WALL IF ANY CE- BEN- FILTER PACK <br /> MENT TONI FILL <br /> Ft to Fc m 0 v LL (Inches) THICKNESS (Inches) Ft. to FL ✓ ✓ ✓ (TYPE/SIZE) <br /> (_) U <br /> 0 140 20 ./ <br /> 140 200 v, .045 50 200 GRAVE <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,FIRPO N) ('iY E I -ED) <br /> — Soil/Water Chemical Analysis 119AIbe <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IFITEXISTS Signed05/12/17 668622 <br /> WELL DRILLER/AM1THORl7%Q&APM:PPPqM"TATn1VFr: DATE SIGNED C57 LICENSE NUMBER <br /> DWR 198 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />