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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 t,, In.,ir rction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95215 No-e0368083 <br /> ❑ <br /> Date Work Began 8/7/2018 Ended8/9/2018_ LATITUDE LONGITUDE <br /> Local Permit Agency Fnvirnnmental Health <br /> Permit No. wp0038611 Permit Date 7/28/2018 APN/rRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL _HORIZONTAL —ANGLE —(SPECIFY) Name Moormans Water Systems <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 2120 Wilcox Rd <br /> SURFACEDESCRIP'T'ION Stockton CA 95215 <br /> Ft. to Ft. Describe material grain, Size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 1057 Paluma Ave ELL LOCATIO <br /> 3 20 Clay City Stockton CA 95209 <br /> 20 24 Sand County San Joaquin <br /> 24 58 Clay APN Book Page Parcel <br /> 58 60 1 Sand <br /> 60 112 Clay Township Range Section <br /> Latitude I 1 1 <br /> 112 120 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 120 150 Clay LOCATION SKETCH ACTIVITY �✓) <br /> NORTH --V—" NEW WELL <br /> 150 152 Sand <br /> 152 195 Blue Clay MODIFICATDee en IONIREPAIR <br /> P <br /> 195 212 Sand —other(Specify) <br /> 212 225 Clay <br /> _ DESTROY(Describe <br /> Procedures and Materials <br /> Under"GEOLOGIC LOG" <br /> PLANNED USES <br /> WATER SUPPLY <br /> ~ 1ZDomestic Public <br /> LU <br /> Q Irrigation _ Industrial <br /> ul MONITORING— <br /> TEST WELL <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH— <br /> INJECTION— <br /> VAPOR EXTRACTION <br /> SPARGING— <br /> SOUTH REMEDIATION— <br /> Illustmte 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 <br /> DEPTH OF STA <br /> C <br /> WATER LEVEL (Ft.)&DATE MEASURED 8/9/2018 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 225 (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 215 (Feet) May not be representative of a well's long-term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE B OLE aly�PE -!'L FROM SURFACE TYPE <br /> DIA. MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) GRADE DIAMETER OR WALL F ANY FILTER PACK <br /> MENT TONI FILL <br /> Ft to Ft. (Inches) THICKNESS (Inches) Ft. to FL (✓) �) (TYPE/SIZE) <br /> 0 195 12 <br /> 195 2151 1 vi 1 .045 104 215 � 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,FIRM.OR CORPORATION) (TYPED OR PRINTED) <br /> — SoiVWater Chemical Analysis 119 Albers Rd Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 08/23/18 668622 <br /> WELL DRILLERIAUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />