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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 I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95215 No.e0369866 <br /> Date Work Began 10/16/2018 , Ended10/17/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I I I I I I I I I L . <br /> Permit No. wp0038843 Permit Date 10/3/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -,/-VERTICAL HORIZONTAL —ANGLE —(SPECIFY) Name Moormans Water Systems <br /> DRILLING ROTARY <br /> DEPTRH FROM METHOD DESCRIPTION FROM Mud Mailing Address 2120 Wilcox Rd <br /> Stockton CA 95215 <br /> Ft. to Ft. Describe material grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 9716 Leland Way ELL LOCATIO <br /> 3 53 Clay City Stockton CA 95212 <br /> 53 60 Sand County San Joaquin <br /> 60 75 Clay APN Book Page Parcel <br /> 75 84 Sand Township Range Section <br /> 84 127 Clay Latitude I I I <br /> 127 133 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 133 135 Clay LOCATION SKETCH ACTIVITY (v–) <br /> NORTH --*/— NEW WELL <br /> 135 142 Sand MODIFICATION/REPAIR <br /> 142 146 Clay —Deepen <br /> 146 150 Sand —Other(Specify) <br /> 150 158 Clay DESTROY <br /> escribe <br /> 158 160 Sand Procedures a0nd Materials <br /> Under"GEOLOGIC LOG' <br /> 160 174 Clay PLANNED USES() <br /> 174 221 Sand WATER SUPPLY <br /> F­ �Domestic_ Public <br /> 221 232 Clay U) w <br /> 232 236 Sand 3 — Irrigation — Industrial <br /> 236 245 Clay MONITORING- <br /> 245 246 Sand TEST WELL— <br /> ATHODIC PROTECTION- <br /> 246 280 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 STATIC 10/17/2018 <br /> WATER LEVEL 0 (Ft.)&DATE MEASURED <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE _ <br /> TOTAL DEPTH OF BORING 280 (Feet) TEST LENGTH <br /> (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 250 (Feet) M not be representative o a well's long-term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE <br /> E ✓ FROM SURFACE TYPE <br /> DIA. ZTYPE <br /> a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) p GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTERPACK <br /> Ft. to Ft. v LL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) U [TYPE/SIZE) <br /> 0 230 12 PI ARTIC 6 900 0 108 <br /> 230 250 .045 108 2 L <br /> ATTACHMENTS (✓ ) CERTIFICATION STATEMENT <br /> — Geologic Log 1,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),:ITYPEb OR PRINTED) <br /> — SoilWater Chemical Analysis 119 Albers Rd Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 10/26/18 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 />