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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPO <br /> Page 1 of 1 Refer to Instruction Pamphlet STATE WELL N0./STATION NO. <br /> Owner's Well No. 95320 No.e0369862 ❑ ❑ <br /> Date Work Began 10/17/2018 Ended10/18/0218 _ LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health <br /> Permit No. wp0038887 Permit Date 10/15/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -+L VERTICAL —HORIZONTAL ANGLE —(SPECIFY) Name David Alvarez <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 26449 Catherine Way <br /> SURFACEDESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 26446 Catherine�ay LOCATio <br /> 3 6 Sand Cit,Escalon CA 95320 <br /> 6 12 Clay county San Joaquin <br /> 12 221 Sand APN Book Page Parcel <br /> 22 281 Clay Township Range Section <br /> 28 38 Sand Latitude I I <br /> 38 117 'Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 117 120 Sand LOCATION SKETCH ACTIVITY ) <br /> Sand <br /> NORTH --N/— NEW WELL <br /> 123 153 MODIFICATION/REPAIR <br /> 153 156 Sand —Deepen <br /> 156 169 Clay —other(Specify) <br /> 169 170 Sand <br /> — <br /> DESTROY (Describe <br /> 170 172 Clay Procedures and Materials. <br /> Under"GEOLOGIC LOG' <br /> 172 175 Sand PLANNED USES() <br /> 175 188 Clay WATER SUPPLY <br /> 188 193 Shale Domestic— Public <br /> 193 196 Clay — Irrigation — Industrial <br /> 196 197 Sand MONITORING— <br /> TEST WELL- <br /> 197 210 Clay ATHODIC PROTECTION- <br /> 210 213 Gravel HEAT EXCHANGE- <br /> 213 217 Clay DIRECT PUSH_ <br /> 217 221 Sand INJECTION— <br /> VAPOR EXTRACTION— <br /> 221 250 Clay 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 STATbC10/18/2018 <br /> WATER LEVEL 4 (Ft.)&DATE MEASURED <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 250 (Feet) TEST LENGTH <br /> (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 225 (Feet) Mav not be representative o a well's long-term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE !) FROM SURFACE TYPE <br /> DIA. Y W a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) m W p J GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER Z CK <br /> Ft. to Ft. g 0 Inches THICKNESS (Inches) Ft. to Ft. ✓ ONI �) <br /> En U- <br /> 0 205 12 <br /> 205 225 .04L 108 225 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 /> — SoillWater Chemical Analysis 119 Albers Rd Modesto CA 95357 <br /> Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 10/19/18 668622 <br /> 11 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 />