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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — 00 NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 2 of 2 Refer to Invrvetion Pamphlet STATE WELL NOJ STATION NO, <br /> Owners Well No. 95320 No.e0369852 L i DE11 ❑ <br /> Date Work Began 10/5/2018 , Ended LATITUDE LONGITUDE <br /> Local Permit Agency FnvirnnmPntal Health <br /> Permit No. Wp0038758 Permit Date 9/102018 APWTRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(K) 0-VERTICAL ___HORIZONTAL ANGLE —(SPECIFY) Name Joe 03S0V3 <br /> DRILLING ROTARY Mailing Address 2468 Mari esa R <br /> DEPTH FROM METHOD FLUID Mud g R <br /> DESCRIPTION Escalon CA 95320 <br /> Ft to Ft Describe material, grab[, size, color, etc. CITY STATE ZIP <br /> 361 364 Shale LL LOCATION <br /> Address 23335 Dodds R <br /> 364 371 Black Sand City Escalon CA 95320 <br /> 371 390 Shale CountySan Joa(Itlin <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 ACTWITY V) <br /> NORTH __t/_ NEW WELL <br /> 416 432 Shale <br /> MODIF{CATIONIREPAIR <br /> 432 438 Black Sand —Deepen <br /> 438 440 Shale —Dher(Spear) <br /> 440 450 Black Sand <br /> — DESTROY (Descrbe <br /> 450 479 Shale Mat <br /> Prooadua and Materiels <br /> Lltl W"GEOLOGIC L <br /> 479 484 Black Sand PLANNED USES() <br /> 484 494 Shale WATER SUPPLY <br /> ~ <br /> Domestic Pubic <br /> 494 5161 Black SandIn; , _ ,tla,elt;r <br /> 516 534 Shale <br /> MONITORING- <br /> 9.34 538 Mack Sand <br /> TEST WELL- <br /> 538 571 Shale ATMODIC PROTECTION- <br /> 571 577 Black Sand HEAT EXCHANGE- <br /> 577 581 Shale DIRECT PUSH_ <br /> 581 W41 Black Sand INJECTION <br /> VAPOR EXTRACTION— <br /> 584 600 Shale SPARGING_ <br /> SOUTH REMEDIATION— <br /> 01.n-m a D-0,Did ft—nfW-R fi—R—L,, Bruch,,, <br /> Foocca,Rivas,etcand attKh a map. Uae addbww papa if OTHER(SPECIFY)— <br /> awwwu7.PLEASE BE ACCURATE E COMMXM <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER-- (Ft)BELOW SURFACE <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft)&DATE MEASURED <br /> ESTIMATED YIELD ' (GPM)6 TEST TYPE <br /> TOTAL DEPTH OF BORING 6W (Fed) TEST LENGTH (Hm.) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL (Fed) May not be representative a a well's lone-term vieU <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE s FROM SURFACE E <br /> DIA. Z a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inch") o_ GRADE DIAMETER OR WALL IF ANY MENT TOMT FILL FILTER PACK <br /> FL to Ft ao v (InUra) THICKNESS (Inches) Ft to Ft (TYPE/SIZE) <br /> (�) L) <br /> ATTACFM0IT 7S CERTIFICATION STATEMENT <br /> — G+oiw Loy 1,the indweignack ceftey fila[MIs report Is omVkft and aomwift to to but d my Ivvwled"and befei. <br /> — yw cairer CbW Digan 1VAME MASELLIS DRILLING INC <br /> — G*Whyeid Log($) (PERSON,FIRM,OR CORPORATION (TYPED OR PRINTED) <br /> Sdff4dr CtNmcel Ata*m 119 Abm RA Modesto CA 95357 <br /> — Ods ADDRESS CITY STATE ZIP <br /> ATTACHAADMONALN*0RMA71aV.IFITEXSTS. 10/05/18 66 22 <br /> WELL DRILLER/AUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR to REV.11-97 IF ADDMONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />