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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — O NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 1 of 2 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95336 NO.e0339658 11 11 111111 ❑ <br /> Date Work Began 3/28/2017 Ended4/18/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I I I I I I I I I I <br /> Permit No. Permit Date <br /> 76878 3/3/2017 APNITRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) --,' VERTICAL HORIZONTAL — ANGLE (SPECIFY) Name Sylvia Lopes <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 15505 S.Austin Rd <br /> SURFACE DESCRIPTION Manteca CA 95336 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITE' E STATE ZIP <br /> 0 9 Sand Address 15505 S.Austin"NdLL LOCATIO <br /> 9 68 Clay City Manteca CA 95336 <br /> 68 70 Sand CountySan Joaquin <br /> 70 74 Clay APN Book Page Parcel <br /> 74 75 Sand Township Range Section <br /> 75 85 Clay Latitude I l <br /> 85 89 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 89 91 Clay LOCATION SKETCH ACTIVITY (✓) <br /> 91 97 Shale NORTH I/ NEW WELL <br /> 97 101 Cla MODIFICATION/REPAIR <br /> y —Deepen <br /> 101 116 Sand —Other(Specify) <br /> 116 117 Clay <br /> es doe <br /> 117 128 Sand — Procedures re OY a0nd Materials <br /> Under"GEOLOGIC LOG' <br /> 128 164 Clay PLANNED USES() <br /> 164 170 Sand WATER SUPPLY <br /> 170 186 Clay Domestic— Public <br /> 186 210 Shale Irrigation _ Industrial <br /> — <br /> 210 223 Clay MONITORING <br /> TEST WELL— <br /> 223 225 Sand ATHODIC PROTECTION- <br /> 225 229 Clay HEAT EXCHANGE- <br /> 229 232 Sand DIRECT PUSH_ <br /> 232 256 Shale INJECTION— <br /> VAPOR EXTRACTION— <br /> 256 266 Clay SPARGING_ <br /> 266 270 Sand SOUTH REMEDIATION <br /> — <br /> Illustrate or Describe Distance of Well from Roads, Buildings. <br /> 270 272 Shale Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)- <br /> 272 276 Sand necessary. PLEASE BE ACCURATE & COMPLETE. <br /> 276 285 Shale WATER LEVEL&YIELD OF COMPLETED WELL <br /> 285 292 Sand DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> 292 296 Clay DEPTH OF STATI4C <br /> 296 305 Sand WATER LEVEL V4 (Ft.)&DATE MEASURED 4/3/2017 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 345 (Feet) TEST LENGTH <br /> (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 335 (Feet) May not be representative o a well's long-term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓) FROM SURFACE TYPE <br /> DIA. Y w a MATERIAL t INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z w O °' GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft. to Ft. m Co v Co (Inches) THICKNESS (Inches) Ft. to Ft. (TYPE/SIZE) <br /> 0 295 20 v PLASTic 12, 200 0 50 <br /> 295 335 VE <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,OR CORPORATION) (TYPE OR PRINTED) <br /> — SoiUWater Chemical Analysis 11 7 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Sig04/18/17 668622 <br /> WELL D LL / UTHO D REPqEPENTATIVC DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NE ED,USE NEXT CONstclITIVE1 Y NUMBERED FORM <br />