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QUADRUPLICATE STATE OF CALIFORNIA <br />For Local Requirements WELL COMPLETION REPORT <br />Page I of I Refer to Instruction Pamphlet <br />Owner's Well No. 95366 No -e0368096 <br />Date Work Began 9/4/2018 Ended9/6/2018 <br />Local Permit Agency Environmental Health <br />Permit No. wp0038714 Permit Date 8/28/2018 <br />GEOLOGIC LOG <br />ORIENTATION (✓) <br />DEPTH FROM <br />Ft. to Ft. <br />-L VERTICAL — HORIZONTAL — ANGLE —(SPECIFY) <br />DRILLING ROTARY <br />METHOD FLUID Mud <br />DESCRIPTION <br />Describe material, grain, size, color, etc. <br />0 3 <br />Top Soil <br />3 7 <br />Sand <br />7 43 <br />Clay <br />43 48 <br />Sand <br />48 59 <br />Clay <br />59 62 <br />Sand <br />62 73 <br />Clay <br />73 79 <br />Sand <br />79 118 <br />Clay <br />118 155 <br />Sand <br />155 170 <br />Clay <br />170 176 <br />Sand <br />176 235 <br />Clay <br />235 240 <br />Sand <br />2401 280 <br />Clav <br />TOTAL DEPTH OF BORING 280 (Fed) <br />TOTAL DEPTH OF COMPLETED WELL250 (Feet) <br />Name Robert Kamps <br />Mailing Address 211; <br />DWR USE ONLY — DO NOT FILL IN <br />STATE WELL NO./ STATION NO. <br />1111 11:101 [1 11, El <br />LATITUDE LONGITUDE <br />APNITRS/OTHER <br />WELL OWNER <br />Rip[on <br />CA 95366 <br />CITY <br />STATE ZIP <br />Address 18801 S. Murphy Aht, LOCATION <br />— Other (Specify) <br />City Ripon CA 95366 <br />0 230 <br />County San Joaquin <br />Procedures and Material; <br />APN Book Page Parcel <br />Under "GEOLOGIC LOG' <br />Township Range Section <br />PLANNED USES <br />Latitude t <br />I <br />DEG. MIN. SEC. <br />DEG. MIN. SEC. <br />LOCATION SKETCH _TACTIVITY <br />(✓) — <br />NORTH <br />I VNEW WELL <br />DEPTH <br />FROM SURFACE <br />MODIFICATION/REPAIR <br />CASING (S) <br />— Deepen <br />MATERIAL / INTERNAL GAUGE SLOT SIZE <br />GRADE DIAMETER OR WALL IF ANY <br />(Inches)THICKNESS (Inches) <br />— Other (Specify) <br />— DESTROY (Describe <br />0 230 <br />11 <br />Procedures and Material; <br />Under "GEOLOGIC LOG' <br />PLANNED USES <br />45 <br />WATER SUPPLY <br />Domestic Public <br />Q <br />LLJ <br />— <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 />REMEDIATION <br />SOUTH <br />Illustrate or Describe Distance of Wellfrom Roads, Buildings, <br />_ <br />Fences, Rivers, etc. and attach a map. Use additional paper if <br />OTHER (SPECIFY)— <br />necessary. PLEASE BE ACCURATE & COMPLETE. <br />WATER LEVEL & YIELD OF COMPLETED WELL <br />1 <br />DEPTH TO FIRST WATER (Ft.) BELOW SURFACE <br />DEPTH OF STAT& <br />9/6/2018 <br />WATER LEVEL (Ft.) & DATE MEASURED <br />ESTIMATED YIELD (GPM) & TEST TYPE _ <br />TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br />DEPTH <br />FROM SURFACE <br />BORE- <br />(Inches) <br />CASING (S) <br />MATERIAL / INTERNAL GAUGE SLOT SIZE <br />GRADE DIAMETER OR WALL IF ANY <br />(Inches)THICKNESS (Inches) <br />fPEHOLEDIA. <br />Ft. to FL <br />0 230 <br />11 <br />230 250 <br />45 <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 NUMBE <br />DWR 199 REV. 11-97 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />