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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 Pamphlet STATE WELL N0./STATION NO. <br /> Owner's Well No. 95320 NO.e0369852 I D❑ ❑ <br /> Date Work Began 10/5/2018 Ended LATITUDE LONGITUDE <br /> Local Permit Agency Fnvimnmental Health EL I I I I I I I. I I _ _, <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 ROTARY <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. CITY STATE zIP <br /> 0 3 Top Soil Address 23335 Dodds RaVELL LOCATION <br /> 3 7 Hard Pan Cit,Escalon CA 95320 <br /> 7 9 Sand CotmtySan Joaquin <br /> 9 13 Shale <br /> APN Book Page Parcel <br /> 13 16 Sand Township Range Section <br /> 16 43 Shale Latitude I I I <br /> 43 61 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 611 68 Sand LOCATION SKETCH ACTIVITY ) <br /> 68 140 Clay NORTH —I/— NEW WELL <br /> 140 146 Gravel MODIFICATION/REPAIR <br /> —Deepen <br /> 146 149 Clay —other(Specify) <br /> 149 151 Gravel <br /> 151 163 Clay — DESTROY a0nd Materials <br /> 163 166 Sand and Gravel Under"GEOLOGIC LOG' <br /> PLANNED USES() <br /> 166 192 Shale WATER SUPPLY <br /> 192 195 Sand and Gravel N y Domestic Public <br /> 195 201 Shale Lu Irrigation _ Industrial <br /> 201 208 Sand MONITORING— <br /> TEST WELL- <br /> 208 214 Shale ATHODIC PROTECTION- <br /> 214 215 Sand HEAT EXCHANGE- <br /> 215 230 Clay DIRECT PUSH_ <br /> 230 242 Sand INJECTION— <br /> VAPOR EXTRACTION— <br /> 242 253 Shale SPARGING_ <br /> 253 260 Sand and Gravel SOUTH REMEDIATION <br /> — <br /> Illustrate or Describe Distance of Well from Roads. Buildings, <br /> 260 311 Shale Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)_ <br /> 311 317 Black Sand neceuary. PLEASE BE ACCURATE & COMPLETE. <br /> 317 334 Shale WATER LEVEL&YIELD OF COMPLETED WELL <br /> 334 337 Black Sand DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> .337 356 Shale DEPTH OF STATIC <br /> 356 361 Black Sand WATER LEVEL 113.2 (Ft.)&DATE MEASURED 10/18/2018 <br /> TOTAL DEPTH OF BORING 600 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 600 (Feet) May not be representative of a well's lon -term yield <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE > FROM SURFACE TYPE <br /> DIA. Y W a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- TOT PACK to Ft. (Inches) g Ir z j GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> m L) (Inches) THICKNESS (Inches) Ft. to Ft. (TYPE/SIZE) <br /> to u. ✓ (✓) (✓) <br /> 0 230 24 <br /> 230 270 0 50 600 V GRAVEL <br /> 270 4001 16 1/4 <br /> 400 600 V .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 INFORMA77ON,IF IT EMSTS. Signed 11/12/18 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 />