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QUADRUPLICATE STATE OF CALIFORNIA <br />For Local Requirements WELL COMPLETION REPORT <br />Page 1 of l Refer to Instruction Pamphlet <br />Owner's Well No. 95320 No. e0349119 <br />Date Work Began 7/31/2017 , Ended8/1/2017 <br />Local Permit Agency Environmental Health <br />Permit No. wp0036960 Permit Date 7/28/2017 <br />GEOLOGIC LOG <br />ORIENTATION (✓) VERTICAL — HORIZONTAL — ANGLE —(SPECIFY) <br />DRILLING ROTARY <br />DEPTH FROM METHOD FLUID Mud <br />'SURFACEDESCRIPTION <br />I. to <br />Ft. I <br />Describe <br />0 <br />3 1 <br />Top Soil <br />3 <br />61 <br />Hard Pan <br />6 <br />251 <br />Clay <br />25 <br />401 <br />Sand <br />40 <br />581 <br />Clay <br />58 <br />681 <br />Sand <br />68 <br />105 <br />Clay <br />105 <br />107 <br />Gravel <br />107 <br />118 <br />Clay <br />118 <br />124 <br />Gravel <br />124 <br />128 <br />Clay <br />128 <br />133 <br />Gravel <br />1331 <br />1841 <br />Clay <br />1841 <br />1861 <br />Sand <br />1971 1981 Sand <br />1981 2321 Clay <br />1 2331 2381 Shale <br />2411 2461 Clay <br />2461 247 Sand <br />2471 2601 Shale <br />TOTAL DEPTH OF BORING 260 (Feet) <br />TOTAL DEPTH OF COMPLETED WELL 202 -(Feet) <br />color, etc. <br />Name Rick Dodge <br />Mailing Addresses <br />DWR USE ONLY — DO NOT FILL IN <br />STATE WELL NO./ STATION NO. <br />LATITUDE LONGITUDE <br />APN/TRS/OTHER <br />WELL OWNER <br />Escalon CA 95320 <br />CITY STATE ZIP <br />Address 27402 Sorrenti Lin LOCATIOI" <br />City Escalon CA 95320 <br />CountySan Joaquin <br />APN Book Page Parcel <br />Township Range Section <br />Latitude I I I <br />DEG. MIN. SEC. DEG. MIN. SEC. <br />LOCATION SKETCH --�-ACTIVITY (✓_) — <br />NORTH --VL NEW WELL <br />F <br />L <br />LU <br />SOUTH <br />Illustrate or Describe Distance of Well from Roads, Buildings, <br />Fences, Rivers, etc. and attach a map. Use additional paper if <br />necesaary. PLEASE BE ACCURATE & COMPLETE. <br />MODIFICATIONIREPAIR <br />— Deepen <br />— Other (Specify) <br />— DESTROY (Describe <br />Procedures and Materials <br />Under"GEOLOGIC LOG' <br />PLANNED USESO <br />WATER SUPPLY <br />Domestic — Public <br />Irrigation Industrial <br />MONITORING — <br />TEST WELL <br />,ATHODIC PROTECTION— <br />HEAT EXCHANGE— <br />DIRECT PUSH__ <br />INJECTION <br />VAPOR EXTRACTION — <br />SPARGING <br />REMEDIATION <br />OTHER (SPECIFY)— <br />WATER LEVEL & YIELD OF COMPLETED WELL <br />DEPTH TO FIRST WATER (Ft) BELOW SURFACE 1 <br />DEPTH OF STATIC <br />WATER LEVEL- (Ft.) & DATE MEASURED 8/1/2017 <br />ESTIMATED YIELD (GPM) & TEST TYPE <br />TEST LENGTH (Hra.) TOTAL DRAWDOWN (Ft.) <br />May not be representative of a well's long-term yield. <br />DEPTH ANNULAR MATERIAL <br />FROM SURFACE TYPE <br />CE- BEN- FILTER PACK <br />Ft. to Ft. MENT TON FILL <br />CiO(✓) (J (TYPE/SIZE) <br />0 104 <br />104 202G AVEL <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 />Log(s) <br />— Geophysical Los) (PERSON, FIR I (PYRE P [� <br />— Soil/Water Chemical Analysis 119 AlbersModesto CA 95357 <br />— Other ADDRESS CITY STATE ZIP <br />ATTACH ADDITIONAL INFORMATION, IF IT EXISTS. Signed 08/04/17 668622 <br />WELL DRILLER/AUTHORIZEDPRESEN TIVE DATE SIGNED C-57 LICENSE NUM BE <br />DWR 188 REV. 11-97 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />