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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — O 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. 95320 No.e0368092 <br /> Date Work Began 8/31/2018 Ended9/4/2018 _ LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health <br /> Permit No. wp0038722 Permit Date 8/29/2018 APNITRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Caleb Cox <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 22555 Arthur Rd <br /> SURFACEDESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 22555 Arthur R?ELL LOCATION <br /> 3 7 Hard Pan City Escalon CA 95320 <br /> 7 44 Sand CountySan Joaquin <br /> 44 50 1 Shale APN Book Page Parcel <br /> 50 58 Gravel Township Range Section <br /> 58 87 Shale Latitude t I i <br /> 87 103 Gravel DEG. MIN. SEC. DEG. MIN. SEC. <br /> 103 114 Shale LOCATION SKETCH ACTIVITY (�) <br /> NORTH I/ NEW WELL <br /> 114 120 Sand <br /> 120 132 Clay MODIFICATIIONIREPAIR Deepen <br /> 132 140 Sand —other(Specify) <br /> 140 1541 Clay <br /> 154 185 Hard Shale — Proc <br /> edures Ta reg and Materials <br /> 185 217 Clay <br /> Under"GEOLOGIC LOG" <br /> PLANNED USES(} <br /> 217 245 Sand WATER SUPPLY <br /> 245 251 Clay W -AL Domestic— Public <br /> Lu <br /> 251 256 Sand Irrigation — Industrial <br /> � u� <br /> 256 274 Shale MONITORING— <br /> TEST WELL- <br /> 274 285 Sand ATHODIC PROTECTION_ <br /> 285 295 Clay 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 STATJC <br /> WATER LEVEL�`'8 (FL)8 DATE MEASURED 9/4/2018 <br /> TOTAL DEPTH OF BORING 295 ESTIMATED YIELD • (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN <br /> (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 290 (Feet) Mary not be representative o a well's Ion -term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE fTYPE ✓ FROM SURFACE TYPE <br /> DIA. MATERIAL/ INTERNAL GAUGE SLOT SIZE(Inches) a DIAMETER OR WALL IF ANY CE- BEN- FILTER PACK <br /> Ft to Ft GRADE MENT TONIT FILLLL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ ✓ ✓ (TYPElSIZE) <br /> 0 270 11 PLASTIC 6 200 0 200 <br /> 270 290 v .045 200 290 GRAVEL <br /> ATTACHMENTS (4) 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 /> 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 />