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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT lliililliii <br /> Page 1 of 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95320 NO.e0369857 I ❑ <br /> Date Work Began 10/9/2018 Endedl O/10/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Envirommnetal Health <br /> Permit No.X0038851 Permit Date 10/4/2018 APNITRSIDTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL HORIZONTAL —ANGLE —(SPECIFY) Name Patty Amador <br /> DRILLING ROTARY M Mailing Address 30685 E. Lee Rd <br /> DEPTH FROM METHOD FLUID Mud g <br /> DESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE zip <br /> 0 3 Top Soil 30399 Lee Rd WELL LOCATIO <br /> 3 20 Gravel Address <br /> City Escalon CA 95320 <br /> 20 53 Clay County San Joaquin <br /> 53 71 Gravel <br /> 71 78 Clay APN Book Page Parcel <br /> 78 89 Sand Township Range Section <br /> Latitude I I I <br /> 89 125 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 125 128 Sand LOCATION SKETCH ACTIVITY (✓) <br /> 128 152 Clay NORTH --V—' NEW WELL <br /> MODIFICATIONIREPAIR <br /> 152 154 Sand —Deepen <br /> 154 180 Clay —Other(Specify) <br /> 180 1831 Sand <br /> — <br /> DESTROY(Describe <br /> 183 189 Clay Procedures <br /> ro edures"GEOLOGICan ateOG" <br /> 189 190 Sand UndPLANNED USES() <br /> 190 242 Clay WATER SUPPLY <br /> 242 245 Sand J --V� Domestic— Public <br /> Lj <br /> 245 268 Clay — Irrigation — Industrial <br /> 268 270 Gravel MONITORING— <br /> TEST WELL <br /> 270 280 Clay 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 STAT C <br /> WATER LEVEL 8 (Ft.)&DATE MEASURED 10/10/2018 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 280 (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (FL) <br /> TOTAL DEPTH OF COMPLETED WELL 252 (Feet) Mav not be representative o a well's lon -term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓) FROM SURFACE p <br /> DIA. Y w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z p a GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> Ft. to Ft. m v LL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ ✓ ✓ (rYPE/SIZE) <br /> 0 232 105/8 <br /> 232 252 .045 106 252 GRAVEL <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 /> — SoiVWater Chemical Analysis 119 Albers RdModesto CA 95357 <br /> Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 10/19/18 668622 <br /> WELL DRILLERIAUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />