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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 1 of I Refer to Instruction Pamphlet STATE WELL NO./STATION N0, <br /> Owner's Well No. 93930 N° e0369873 <br /> Date Work Began 10/22/2018 , Endedl O/26/2018 LATITUDE LONGITUDE ❑ <br /> Local Permit Agency Enviranmental Health I i I I I I I I I I I <br /> Permit No. wp0038849 Permit Date 10/4/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Tim Benedix <br /> DRILLING <br /> DEPTH FROM METHOD ROTARY FLUID Mud Mailing Address 44753 Sun Valley Dr <br /> SURFACEDESCRIPTION King City CA 93930 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 8225 S Henry Rd ELL LOCATION <br /> 3 17 Clay City Farmington CA 95320 <br /> 17 28 Sand County San Joaquin <br /> 28 72 Shale APN Book Page Parcel <br /> 72 88 Sand Township Range Section <br /> 88 117 Clay Latitude I I I _ <br /> 117 150 Shale DEG. MIN. SEC. DEG. MIN. SEC. <br /> 150 161 Clay LOCATION SKETCH ACTIVITY (✓) <br /> 1611 165 Sand NORTH -.*/— NEW WELL <br /> 165 190 Clay MODIFICATII8eN//RRrEPAIR <br /> 190 194 Sand —Other(Specify) <br /> 194 197 Clay <br /> DESTROY °d at197 198 Sand r (Describe <br /> Under"GEOLOGIC LOG' <br /> 198 229 Clay PLANNED USES(.) <br /> 229 231 Sand WATER SUPPLY <br /> ~ f- Domestic— Public <br /> 231 239 Clay V) rn <br /> 239 264 Black Sand Irrigation Industrial <br /> 264 268 Clay MONITORING— <br /> TEST WELL— <br /> 268 270 Sand ATHODIC PROTECTION- <br /> 270 285 Shale HEAT EXCHANGE— <br /> DIRECT PUSH_ <br /> INJECTION— <br /> VAPOR EXTRACTION— <br /> SPARGING <br /> SOUTH REMEDIATION— <br /> filwtmte 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 At YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STATIC <br /> WATER LEVEL 150 (Ft.)&DATE MEASURED 10/26/2018 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 285 (Feet) TEST LENGTH <br /> TOTAL DEPTH OF COMPLETED WELL270 Feet (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> (Feet) M not be representative o a well's lon -term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓) FROM SURFACE p <br /> DIA. Y w n MATERIAL/ INTERNAL GAUGE SLOT SIZE <br /> CE- BEN- <br /> Ft. to Ft. (Inches) g p a GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> m y O LL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) L) (TYPE/SIZE) <br /> 0 250 11 1/ PI ARTIC 6 200 0 100 <br /> 250 270 .045 1 100 270 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 /> — SoilfWater Chemical Analysis 119 Albers Rd Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EMSTS. Signed 11/20/18 668622 <br /> WELL DRILLER/AUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 189 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />