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QUADRUPLICATE STATE OF CALIFORNIA OWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 1 of 1 Refer to Instruction Pamphlet STATE WELL N0./STATION NO. <br /> Owner's Well No. 95320 No-e0369865 <br /> Date Work Began 10/23/2018 Ended10/24/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Envirenirri Health I I I I I I I I I I I I_, <br /> Permit No. wp0038905 Permit Date 10/18/2018 APWrRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) v/ VERTICAL —HORIZONTAL — ANGLE —(SPECIFY) Name Richard Schmidig <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 13883 Escalon Bellota Rd <br /> DESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address_13883 Escalon MoRaWfATlo <br /> 3 7 Hard Pan Cit,Escalon CA 95320 <br /> 7 10 Clay County San Joaquin <br /> 10 38 Sand <br /> 38 88 Clay APN Book Page Parcel <br /> Township Range Section <br /> 88 92 Sand Latitude I 1 1 <br /> 92 156 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 156 163 Sand LOCATION SKETCH ACTIVITY (✓) <br /> NORTH I./— NEW WELL <br /> 163 168 Clay <br /> 168 174 Sand MODIFICATION/REPAIR <br /> —Deepen <br /> 174 236 Clay —other(Specify) <br /> 236 237 Sand <br /> DESTROY (Describe <br /> 237 340 Clay Procedures and Materials <br /> 340 341 Sand Under"GEOLOGIC LOG" <br /> PLANNED USES() <br /> 341 368 Clay WATER SUPPLY <br /> ~ <br /> 368 374 Sand U) Domestic Public <br /> 374 381 Clay w — Irrigation — Industrial <br /> 381 387 Sand MONITORING— <br /> TEST WELL <br /> 387 400 Clay — <br /> ATHODIC PROTECTION— <br /> 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 EL TIC <br /> —104 10/24/2018 <br /> WATER LEVEL (Ft.)&DATE MEASURED <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 400 (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 380 (Feet) May not be representative o a well's ion -term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HORS TYPE ✓ FROM SURFACE TYPE <br /> DIA• x w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. to Ft. (Inches) m U BEN- <br /> Z a GRADE (inches)DIAMETER OR <br /> WALL IF ANY(inches) Ft. to Ft. MENT TONIT FILL FILTER PACK <br /> W LL (�) �) (TYPE/SIZE) <br /> 0 360 105/8 PLASTIC 6 900 0 11 <br /> 360 380, .045 110 380 <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 CORPORA-MON) (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. 11 Signed 10/26/18 668622 <br /> WELL DRILLER/AUTHORIZEa-REPRESENTATIVE" DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />