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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. 95361 NO.e0368087 <br /> Date Work Began 8/14/2018 Ended8/16/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I I I I I I I I I I I <br /> Permit No. wp0038647 Permit Date 8/10/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(!) VERTICAL —HORIZONTAL — ANGLE —(SPECIFY) Name Kristopher Fabing <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 12635 Cometa Dr <br /> SURFACEDESCRIPTION Oakdale CA 95361 <br /> Ft. to Ft. ."ribe material, grain, size, color, etc. CITY yy STATE ZIP <br /> 0 2 Top Soil Address 12635 Cometa,WELL LOCATIO <br /> 2 7 Hard Pan City Oakdale CA 95361�� <br /> 7 18 Sand Sand <br /> Co„ntySan Joaquin <br /> 18 25 APN Book Page Parcel <br /> 25 32 Sand Township Range Section <br /> 32 45 Clay Latitude I 1 1 <br /> 45 49 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 49 73 Clay LOCATION SKETCH ACTIVITY L) <br /> NORTH -/ NEW WELL <br /> 73 78 Gravel <br /> MODIFICATION/REPAIR <br /> 78 118 Clay —Deemer <br /> 118 140 Sand —Other(Specify) <br /> 140 171 Clay <br /> 171 180 Sand — DESTROY <br /> Ores a0nd Mat rials <br /> Under"GEOLOGIC LOG" <br /> 180 188 Clay PLANNED USES() <br /> 188 193 Sand WATER SUPPLY <br /> 193 202 Clay w __*Z Domestic— Public <br /> 202 209 Sand — Irrigation — Industrial <br /> 209 212 Clay MONITORING— <br /> TEST WELL_,. <br /> 212 218 Sand ATHODIC PROTECTION- <br /> 218 230 Shale HEAT EXCHANGE- <br /> 230 231 Sand DIRECT PUSH- <br /> 231 262 Shale INJECTION— <br /> 262 263 Sand VAPOR EXTRACTION— <br /> SPARGING— <br /> 263 285 Shale SOUTH REMEDIATION <br /> — <br /> 111ustmie or Describe Disumce 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 110 (Ft.)&DATE MEASURED 8/16/2017 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 285 <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 248 (Feet) Mav not be representative of a well's long-term yield. <br /> DEPTH BORE- CASING(S) _ DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE 1:�PE ✓ FROM SURFACE TYPE <br /> DIA. a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE-Ft. to Ft. LL <br /> (Inches) uj p a GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> (Inches) THICKNESS (Inches) Ft. o Ft. ✓ ✓ ✓ (TYPEISIZE) <br /> (_) U <br /> 0 208 12 PLASTIC 6 200 0 104 <br /> 208 248 104 248 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 /> — SoilfWater 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 />