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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORTTL <br /> Page 1 of 1 Refer to Instruction Pamphlet STATE WELL NO.!STATION NO. <br /> Owner's Well No. 95320 No'e0369860 III , I 11D 1 11710 <br /> Date Work Began 9/26/2018 Ended9/27/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Fnvirnnmental Health I I I I I I I I I I I I I <br /> Permit No. wp0038789 Permit Date 9/20/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL _HORIZONTAL —ANGLE —(SPECIFY) Name Jennell Avila <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 28442 Lemon Ave <br /> SURFACEDESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top SoilAddress 28442 Lemon A BELL LOCATIO <br /> 3 17 Shale City Escalon CA 95320 <br /> 17 27 Sand <br /> 27 50 Clay County San Joaquin <br /> APN Book Page Parcel <br /> 50 53 Sand Township Range Section <br /> 53 61 Clay Latitude I I I <br /> 61 70 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 70 75 Clay LOCATION SKETCH ACTIVITY (✓) <br /> 75 95 Sand and Gravel NORTH -19" NEW WELL <br /> 95 117 Sand MODIFICATION/REPAIR <br /> —Deepen <br /> 117 120 Clay —Other(Specify) <br /> 120 1321 Sand <br /> 132 133 Clay —Pea res (Describe <br /> Materials <br /> Under"GEOLOGIC LOG' <br /> 133 141 Sand PLANNED USES() <br /> 141 147 Clay WATER SUPPLY <br /> 147 152 Sand and Gravel ai Domestic— Public <br /> 152 160 Clay Irrigation — Industrial <br /> 160 170 Sand MONITORING— <br /> TEST WELL— <br /> 170 271 Clay ATHODIC PROTECTION- <br /> 271 273 Sand HEAT EXCHANGE- <br /> 273 285 Clay DIRECT PUSH_ <br /> 285 287 Sand INJECTION— <br /> 287 300 ClayVAPOR EXTRACTION— <br /> SPARGING_ <br /> 300 345 Clay SOUTH REMEDIATION— <br /> Illustrate or Describe Distance of We!lfrom Roads, Buildings, <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)— <br /> necesaary.PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (FL)BELOW SURFACE 1 <br /> DEPTH OF STATg <br /> WATER LEVEL O4 (Ft.)&DATE MEASURED 9/27/2018 <br /> TOTAL DEPTH OF BORING 345 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH-(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 290 (Feet) Mav not be representative of a well's lon -term vield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE aTYPE .:Q FROM SURFACE TYPE <br /> DIA. MATERIAL/ INTERNAL GAUGE SLOT SIZECE- BEN(Inches) GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> Ft. to Ft. (Inches) THICKNESS (Inches) Ft. to Ft. , (✓) �) (TYPE/SIZE) <br /> in <br /> 0 265 11 PLASTIC 81 200 0 200 <br /> 265 290 4 � GRAVEL <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> Geologic Log I,the undersigned,certiry 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 DCISTS. Signed 10/19/18 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 />