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'QUADRUPLICATE STATE OF CALIFORNIA E DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 2 of 2 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95336 NO.e0339658 ❑ [� <br /> Date Work Began 3/28/2017 Ended4/18/2017 _ LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health <br /> Permit No. 76878 Permit Date 3/3/2017 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL HORIZONTAL —ANGLE —(SPECIFY) Name Sylvia Lopes <br /> DRILLING <br /> DEPTH FROM METHOD ROTARY FLUID Mud Mailing Address 15505 S Austin Rd <br /> EURFACE DESCRIPTION Manteca CA 95336 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 305 306 Clay Address 15505 S.Austin%LL LOCATION <br /> 306 312 Sand City Manteca CA 95336 <br /> 312 314 Clay County San Joaquin <br /> 314 320 Sand <br /> 320 322 Clay APN Book Page Parcel <br /> 322 324 Sand Township Range Section <br /> 324 325 Cla Latitude I , <br /> DEG. MIN, SEC. DEG. MIN. SEC. <br /> 325 330 Sand LOCATION SKETCH ACTIVITY (✓) <br /> 330 345 Clay <br /> NORTH NEW WELL <br /> MODIFICATIONIREPAIR <br /> —Deepen <br /> —Other(Specify) <br /> — DESTROY (Describe <br /> Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> PLANNED USES() <br /> F WATER SUPPLY <br /> C!? Dourest c_ Public <br /> Q __3o/_ Irrigation _ Industrial <br /> uJ MONITORING— <br /> TEST WELL <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH_ <br /> INJECTION— <br /> VAPOR EXTRACTION <br /> SPARGING <br /> SOUTH REMEDIATION_ <br /> /llustrate or Describe Distance of Well from Roads, Buildings, <br /> Fences,Rivers,etcand 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 4 (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 of a well's loo -term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE aTYPE _!L) FROM SURFACE TYPE <br /> DIA• MATERIAL/ INTERNAL GAUGE SLOT SIZE(Inches) GRADE DIAMETER OR WALL IF ANY CE- BEN- <br /> Ft. to Ft. MENT TONIT FILL FILTER PACK <br /> (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) U (TYPE/SIZE) <br /> 0 295 20 PLASTIC 12 200 0 501 <br /> 295 335 50 335 R <br /> AVEL <br /> +Ffl <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,FI OR CORPO N) (TYPED R PRINJED) <br /> Soil/Water Chemical Analysis 1 <br /> — Other ADDRESS CITY <br /> STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT IXISTS. S✓ned 04/18/17 668622 <br /> WELL DRILLERIAUTHORIKI EPRES TATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />