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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./STATION NO. <br /> Owner's Well No. 95366 No.e0337045 <br /> Date Work Began 3/2/2016 Ended3/6/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Hanith _ _._ <br /> Permit No. 76539 Permit Date 1/3/2017 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Carol Madsen <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address P.O. BOX 1283 <br /> SURFACE DESCRIPTION Ripon CA 95366 <br /> Ft to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top SOII <br /> _ LL LOCATIO <br /> Address 22808 S. Highlan(Wf <br /> 3 10 Sand _ <br /> City Ripon CA 95366 <br /> 10 16 Clay <br /> County San Joaquin _ <br /> 16 181 Sand APN Book Page Parcel <br /> 18 68 Clay Township Range Section <br /> 68 70 Sand Latitude I l <br /> 70 75 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 75 85 Sand LOCATION SKETCH ACTIVITY (�) <br /> 85 98 Clay <br /> NORTH --V—" NEW WELL <br /> 98 110 Sand MODIFICATION/REPAIR <br /> —Deepen <br /> 110 118 Clay —Other(Stay) <br /> 118 121 Sand <br /> _ DESTROY (Describe <br /> 121 135 Clay Procedures and Materials <br /> 135 138 Sand Under"GEOLOGIC LOG <br /> PLANNED USES(.) <br /> 138 153 Clay WATER SUPPLY <br /> Domestic— Public <br /> 153 162 Sand t- to <br /> 162 163 Clay irrigation _ Industrial <br /> 163 165 Sand MONITORING— <br /> TEST WELL— <br /> 165 169 Clay THODIC PROTECTION- <br /> 169 170 Sand HEAT EXCHANGE- <br /> 170 181 Clay DIRECT PUSH- <br /> 181 200 Sand INJECTION— <br /> VAPOR EXTRACTION— <br /> 200 220 Clay SPARGING— <br /> SOUTH REMEDIATION— <br /> IRustrate or Describe Distance of Wel/from Roads, Ruddings, <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)— <br /> necessary. <br /> SPECIFY)_necessary.PLEASE BE ACCURATE tit COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER- (Ft.)BELOW SURFACE <br /> DEPTH OF STAT C <br /> WATER LEVEL 9 (Ft)&DATE MEASURED 3/2/2017 <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 220 (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL 202 (Feet) May not be representative o a well's lon -teen yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE FROM SURFACE TYPE <br /> DIA. Y W a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft o Ft. (Inches) g p J GRADE DIAMETER OR WALL IF ANY MENT ITONITEFILL FILTER PACK <br /> m (Inches) THICKNESS (Inches) Ft o FL 0D U (TYPE/SIZE) <br /> LL <br /> 0 162 14 <br /> 162 202 58 202 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,FI RP ) D) <br /> — Soil/Water Chemical Analysis 119 Alb Modesto 57 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT D(ISTS. 11 Signed03/06/17 668622 <br /> WELL DRILLER/AUTHORI EPRESE ATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 199 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />