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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page I of I Refer to Instruction Pamphlet STATE WELLNO./STATION NO. <br /> Owner's Well No. 95320 _ No.e0339662 El <br /> Date Work Began 4/12/2017 Ended4/18/2017 _ LATITUDE LONGITUDE <br /> Local Permit Agency Envi arimental Health I I I I I 11 11 1 <br /> P <br /> Permit No. -Permit 77188 Date 4/11/2017 APNfrRSIOTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) ---/–VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Patty Amador <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 30685 Lee Rd <br /> DESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 30065 Lee Rd WELL LOCATION <br /> 3 12 Sand Cit,Escalon CA 95320 <br /> 12 19 Gravel CountySan Joaquin <br /> 19 25 Clay APN Book Page Parcel <br /> 25 39 Sand Township Range Section <br /> 39 54 Gravel Latitude I 1 1 <br /> 54 111 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 111 127 Shale LOCATION SKETCH ACTIVITY (✓) <br /> 127 131 Sand NORTH --L NEW WELL <br /> MODIFICATIONIREPAIR <br /> 131 135 Clay —Deepen <br /> 135 1471 Sand —other(Specify) <br /> 147 150 Clay — DESTROY (Describe <br /> 150 176 Shale Underrdures an"GEOLOGIC 176 185 Sand PLANNED USES() <br /> 185 195 Shale WATER SUPPLY <br /> ~ <br /> 195 200 Sand COOy Domestic— Public <br /> LU <br /> 200 240 Shale Irrigation — Industrial <br /> MONITORING— <br /> TEST WELL—_ <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH_ <br /> INJECTION— <br /> VAPOR EXTRACTION— <br /> SPARGING— <br /> SOUTHREMEDIATION— <br /> Illustrate or Describe Distance oJi1'ell 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 STATIC <br /> WATER LEVEL 45 (Ft.)&DATE MEASURED 4/13/2017 <br /> TOTAL DEPTH OF BORING 240 ESTIMATED YIELD • (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL210 (Feet) May not be representative o a well's lon -term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BOLE TqEvFROM SURFACE TYPE <br /> DIA. y MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN(Inches) Z GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> Ft. to Ft. m (Inches) THICKNESS (Inches) Ft. to Ft ✓ (✓) �) (TYPE/SIZE) <br /> 0 190 11 <br /> 190 210 45 100 210 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, M,OR CORPOW(TYPIDNTED) <br /> — Soil/Water Chemical Analysis 11 AI CA 953 7 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IFITIXISTS. Signed 05/10/17 668622 <br /> WELL DRILLER ALIHO DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE N T CONSECUTIVELY NUMBERED FORM <br />