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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT Ell Iii1i Ili i <br /> Page 2 of 2 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95320 No-e0369852 I I I I I ❑ I I I I ❑ <br /> Date Work Began 10/5/2018 Ended LATITUDE LONGITUDE <br /> Local Permit Agency Envimnmental Health <br /> Permit No. wp0038758 Permit Date 9/10/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -L VERTICAL HORIZONTAL —ANGLE —(SPECIFY) Name Joe DaSilva <br /> DRILLING NARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 2466 Mariposa Rd <br /> SURFACEDESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITE' wSTATE ZIP <br /> UE <br /> LL 364 Shale Address 23335 Dodds Rd LL LOCATIO <br /> 364 371 Black Sand City Escalon CA 95320 <br /> 371 390 Shale County San Joaquin <br /> 390 393 Black Sand APN Book Page Parcel <br /> 393 404 Shale Township Range Section <br /> 404 407 Black Sand Latitude I I <br /> 407 412 Shale DEG. MIN. SEC. DEG. MIN. SEC. <br /> 412 416 Black Sand LOCATION SKETCH ACTIVITY (✓) <br /> NORTH —1v' NEW WELL <br /> 416 432 Shale MODIFICATION/REPAIR <br /> 432 438 Black Sand —Deepen <br /> 438 440 Shale —Other(specify) <br /> 440 450 Black Sand <br /> — DESTROY(Describe <br /> 450 479 Shale Procedures and Materials <br /> 479 484 Black Sand Under"GEOLOGIC LOG' <br /> PLANNED USES() <br /> 484 494 Shale WATER SUPPLY <br /> 494 516 Black Sand co y Domestic— Public <br /> 516 534 Shale Irrigation Industrial <br /> 534 538 Black Sand MONITORING— <br /> TEST WELL_ <br /> 538 571 Shale <br /> ATHODIC PROTECTION- <br /> 571 577 Black Sand HEAT EXCHANGE- <br /> 577 581 Shale DIRECT PUSH_ <br /> 581 584 Black Sand INJECTION <br /> 584 600 Shale 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 <br /> DEPTH OF STATIC <br /> WATER LEVEL 113.2 (Ft.)&DATE MEASURED 10/18/2018 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 600 (Feet) TEST LENGTH <br /> (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 600 (Feet) Mav not be representative of a well's long-term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE v) FROM SURFACE TYPE <br /> DIA. c W a MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z w O ° GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft. to Ft. m y v uJJ (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) 12D (TYPE/SIZE) <br /> 0 230 24 ✓ <br /> 230 270 50 GRAVEL <br /> 270 400 16 1/4 <br /> 400 600 .080 <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 EXISTS. 11 Signed 11/12/18 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 />