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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 I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95236 N°•e0350250 El <br /> Date Work Began 8/9/2017 Ended8/11/2017 _ LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I I I I I I I I I I <br /> Permit No. wp0036989 Permit Date 8/3/2017 APNIrRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(V) VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name R&J Dondero <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 20480 E. CoRperopolis Rd <br /> SURFACEDESCRIPTION Linden CA 95236 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 01 2 Top Soil Address 20120 E. CopperopoksLg�ATIo <br /> 2 43 Cit,Linden CA 95236 <br /> 43 48 Sand <br /> nd County San Joaguin <br /> 48 63 Clay APN Book Page Parcel <br /> 63 73 Sand and Gravel Township Range Section <br /> 73 76 Clay Latitude � I <br /> 76 79 �Sand and Gravel DEG. MIN. SEC. DEG. MIN. SEC. <br /> 79 112 Clay LOCATION SKETCH ACTIVITY (✓ <br /> NORTH --V—" NEW WELL <br /> 112 123 Gravel <br /> 123 145 Clay MODIFICATION/REPAIR <br /> —Deepen <br /> 145 160 Sand and Gravel —other(Specify) <br /> 160 190 Clay <br /> — DESTROY(Describe <br /> 190 195 Sand Procedures and Materials <br /> 195 243 Clay <br /> Under"GEOLOGIC LOG"243 250 Sand PLANNED USES(} <br /> WATER SUPPLY <br /> 250 253 Clay r~n U) _-Z Domestic— Public <br /> 253 257 Sand �$ — Irrigation Industrial <br /> 257 303 Clay MONITORING— <br /> TEST WELL— <br /> 303 307 Sand ATHODIC PROTECTION_ <br /> 307 311 Clay HEAT EXCHANGE- <br /> 311 312 Sand DIRECT PUSH_ <br /> 312 350 Clay INJECTION— <br /> VAPOR EXTRACTION— <br /> 350 351 Sand SPARGING_ <br /> 351 363 Clay SOUTH REMEDIATION— <br /> 363 370 Black Sand Illustrate or Describe Distance of Well from Roads, Buildings, <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER sa (SPECIFY)_ <br /> 370 374 Clay necesry. PLEASE BE ACCURATE & COMPLETE. <br /> 374 405 Clay WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STATIC <br /> WATER LEVEL 146 (Ft.)&DATE MEASURED 8/11/2017 <br /> TOTAL DEPTH OF BORING 405 ESTIMATED YIELD ` (GPM)& TEST TWE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 378 (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 /> Dom• Y wa MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. to Ft. (Inches) g w o a GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> m LL (Inches) THICKNESS (Inches) Ft to Ft. (TYPE/SIZE) <br /> `/ (1�) U-1 <br /> 0 298 14 Pi A.,min 8 200 <br /> 298 318 4 100 7 RAVEL <br /> 318 358 <br /> 358 378 <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> — Geologic Log 1,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,FIR CORPORATA IT(TYp PRINTED) <br /> — SoiUWater Chemical Analysis 1Modestoiz <br /> ADDRESS <br /> — Other (, . CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 08/24/17 668622 <br /> WELL DRILLER/AUTHORIZE RESEN TIVE DATE SIGNED C57 LICENSE NUMBER <br /> DWR 189 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />