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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 N0./STATION NO. <br /> Owner's Well No. 95320 No.e0369871 11 11 =1111 <br /> Date Work Began 10/26/2018 Endedl O/29/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Fnvironmpntal Rpsrntrcps <br /> Permit No. wp0038886 Permit Date 10/15/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) —/_VERTICAL —HORIZONTAL ANGLE —(SPECIFY) Name Richard Sandretto <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 9333 S. Sadie Ln <br /> SURFACEDESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material grain, size, color, etc. CITY STATE ZIP <br /> 0 2 Top Soil Address 9261 S Paddon AqE LL LOCATIO <br /> 2 8 Gravel City Escalon CA 95320 <br /> 8 48 Clay CountySan Joaquin <br /> 48 62 1 Gravel APN Book Page Parcel <br /> 62 1331 Clay Township Range Section <br /> 133 140 Sand Latitude I I l <br /> 1400 155 Gravel DEG. MIN. SEC. DEG. MIN. SEC. <br /> 155 208 Clay LOCATION SKETCH ACTIVITY ) <br /> NORTH _3L NEW WELL <br /> 208 220 Sand MODIFICATION/REPAIR <br /> 220 222 Clay —Deepen <br /> 222 233 Shale —Other(Specify) <br /> 233 235 Sand <br /> DESTROY(Describe <br /> 235 244 Shale Procedures and"GEOLOGIC 244 246 Sand Under PLANNED USES() <br /> 246 260 Shale WATER SUPPLY <br /> 260 263 Sand Domestic Public <br /> 263 325 Shale — lrrigabon — Industrial <br /> 325 339 Black Sand MONITORING- <br /> 339 <br /> ONITORING-339 345 Shale TEST wELL— <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH— <br /> INJECTION— <br /> 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 CONIPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> DEPTH OF STATIC <br /> WATER LEVEL 148 (Ft.)&DATE MEASURED 10/29/2018 <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 345 (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 345 (Feet) May not be representative of a well's loo -term yield. <br /> DEPTH - CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE <br /> BORE <br /> OLE TYPE FROM SURFACE TYPE <br /> DIA. y w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) 5 � Zp J GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> Ft to Ft. m 0 v LL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) �) (TYPE/SIZE) <br /> 0 325 105/8 <br /> 325 345 100 345 VEL <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. Signed 11/20/18 668622 <br /> 11 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 />