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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page I of 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. 7 <br /> Owner's Well No. 95215 No'e0368086 1111 1 1:11111 111 ❑ <br /> Date Work Began 8/812018Ended8/8/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health <br /> Permit No. Wp0038584 Permit Date 7/23/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(K) VERTICAL _HORIZONTAL —ANGLE —(SPECIFY) Name Sam Tanaka <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 3300 Burge Rd <br /> SURFA <br /> CF <br /> DESCRIPTION Stockton CA 95215 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITE' STATE ZIP <br /> 0 3 Top SoilAddress 3_300 Burge Rd WELL LOCATION <br /> 3 15 Clay City Stockton CA 95215 <br /> 15 40 Sand and Gravel CountySan Joaquin <br /> 40 113 Clay APN Book Page Parcel <br /> 113 128 Gravel Township Range Section <br /> 128 154 Clay Latitude I I i <br /> 154 164 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 164 234 Clay LOCATION SKETCH ACTIVITY V) <br /> 234 239 Sand -1/NORTH L NEW WELL <br /> 239 250 Clay MODIFICATION/REPAIR <br /> 2580 258 Sand —Other(Specify) <br /> 258 270 Clay <br /> 270 275 Sand —PPrEocceeddurres OY(Describe <br /> Materials <br /> Under"GEOLOGIC LOG" <br /> 275 278 Clay PLANNED USES() <br /> 278 281 Shale WATER SUPPLY <br /> 281 3001 Clay co 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 /> SOUTH REMEDIATION— <br /> Illustrate or Describe Distance of Well from Roads, Buildings, <br /> Fences,Rivers,etc. and 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 1 <br /> DEPTH OF STATIC <br /> WATER LEVEL 1 (FL)&DATE MEASURED 8/8/2018 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 300 (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN <br /> (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 282 (Feet) May not be representative of a well's long-term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE B ORE MTYPEV FROM SURFACE TYPEDIA. MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. to Ft. (Inches) GRADE D(Inches)R THC NESS (In hes) Ft to Ft.OR WALLMENT TONT FILLFI P�SPIZA,K <br /> (✓_) U <br /> 0 262 12 <br /> 262 282 045 112 `� RAVEL <br /> ATTACHMENTS (,y,) 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) (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 Albers Rd Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed " 08/27/18 668622 <br /> WELL DRILLER/AUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />