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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT I I l i <br /> Page 1 of 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95215 NO.e0368089 <br /> Date Work Began 8/22/2018 Ended8/23/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health <br /> Permit No. wp0038665 Permit Date 8/15/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) �L VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Moorman's Water Systems <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 2120 Wilcox Rd <br /> SURFA EDESCRIPTION Stockton CA 95215 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 2 Top Soil Address 940 W. Sneed RdELL LOCATION <br /> 2 58 Soft Clay City French Camp CA <br /> 58 72 Sand <br /> 72 143 Clay CountySan Joaquin <br /> APN Book Page Parcel <br /> 143. 148 Sand Township Range Section <br /> 148 169 Clay Latitude I I <br /> 169 171 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 171 178 Clay LOCATION SKETCH ACTIVITY (✓) <br /> NORTH --V—" NEW WELL <br /> 178 179 Sand <br /> MODIFICATION/REPAIR <br /> 179 235 Clay —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 /> litigation 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 /> Illustrate or Describe Distance of Welt 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 16 (Ft.)&DATE MEASURED 8/23/2018 <br /> TOTAL DEPTH OF BORING 235 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN <br /> (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 185 (Feet) May not be representative o a well's long-term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE aTYPE -2'�'j FROM SURFACE TYPE <br /> DIA. MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. to p{, (Inches) GRADE DIAMETER OR WALL IF ANY FILTERPACK <br /> (Inches) THICKNESS (Inches) Ft. to Ft. MENT TONI FILL <br /> (✓) (� (TYPE/SIZE) <br /> 0 165 12 <br /> 165 185 45 10 1 `� RAVEL <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 /> — Soil/Water Chemical Analysis 119 Albers Rd Modesto CA 95357 <br /> Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 09/12/18 668622 <br /> 11 WELL DRILLER/AUTHORIZED:REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.I1-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />