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QUADRUPLICATE STATE OF CALIFORNIA ____DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page I of 2 Refer to Instruction Pamphlel STATE WELL NO./STATION NO. <br /> Owner's Well No. 92612 No.e0372165 111 111111 ❑ <br /> Date Work Began 11/8/2018 Endedll/17/201$ LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I I I I I <br /> Permit No. wg0038759 Permit Date 9/10/2018 - APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) aL VERTICAL —HORIZONTAL —ANGLE (SPECIFY) Name Gilmore Rd LLC <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FMailing Address 18301 Von Karman Ste.250 <br /> FLUID Mud <br /> Irvine CA 92612 <br /> SURFACE <br /> Ft. to Ft. Describe material grain, size, color, etc. CITY STATE ZIP <br /> 0 11 Rocks Address 7010 N. Gilmore L LOCATIO <br /> 11 16 Shale City Linden CA 95236 <br /> 16 32 Gravel County San Joaquin <br /> 32 60 Shale APN Book Page Parcel <br /> 60 75 Black Sand <br /> 75 107 Shale Township Range Section <br /> Latitude I 1 1 <br /> 107 112 Black Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 112 130 Shale LOCATION SKETCH ACTIVITY L) <br /> NORTH _3L NEW WELL <br /> 130 148 Black Sand <br /> 148 162 Shale MODIFICATION/REPAIR <br /> —Deepen <br /> 162 200 Black Sand —other(specify) <br /> 200 211 Shale <br /> 211 214 Black Sand —PPrrocedurres(Describe <br /> a d Materials <br /> 214 218 Shale Under"GEOLOGIC LOG' <br /> PLANNED USES() <br /> 218 230 Black Sand WATER SUPPLY <br /> 230 238 ShaleDomestic— Public <br /> Q --%/– Irrigation _ Industrial <br /> 28 241 Black Sand ul <br /> 241 253 Shale MONITORING— <br /> TEST WELL— <br /> 253 262 Black Sand ATHODIC PROTECTION- <br /> 262 264 Shale HEAT EXCHANGE- <br /> 264 267 Black Sand DIRECT PUSH_ <br /> 267 277 Shale INJECTION <br /> VAPOR EXTRACTION— <br /> 277 292 Black Sand SPARGING_ <br /> 292 300 Shale SOUTH REMEDIATION— <br /> Illustrate or Describe Distance of Well from Roads, Buildings, <br /> 300 303 Black Sand Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)- <br /> 303 314 Shale necessary.PLEASE BE ACCURATE & COMPLETE. <br /> 314 320 Black Sand WATER LEVEL&YIELD OF COMPLETED WELL <br /> 320 333 Lost Circulation DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> 333 358 Black Sand DEPTH OF STATI <br /> 358 370 Shale WATER LEVEL 1G75 (Ft)&DATE MEASURED 11/17/2018 <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 600 (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WEL000 (Feet) May not be representative of a well's long-term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE �) FROM SURFACE TYPE <br /> DIA. Y W a MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z W p aJ GRADE DIAMETER OR WALL IF ANY MENT TONI FILL FILTER PACK <br /> FL to Ft. m v LL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) �) (TYPE/SIZE) <br /> to <br /> 0 420 24 ✓ <br /> 420 600 0 50 600 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 /> — Soil/Water Chemical Analysis 119 Albers Rd Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EMSTS. 11 Signed 01/11/19 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 />