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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 NOJ STATION NO. <br /> Owner's Well No. 95215 No-e0369874 ❑ ❑ <br /> Date Work Began 10/30/2018 Ended10/31/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I I I I I I I I I I <br /> Permit No. wp0038892 Permit Date 10/15/2018 APNrrRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(!) VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Moormans Water Systems <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 2120 Wilcox Rd <br /> SURFACE <br /> DESCRIPTION Stockton CA 95215 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 2 Top Soil Address 6786 E Fairchild WELL LOCATIO <br /> 2 120 Clay City Stockton CA <br /> 120 128 Sand County San Joaquin <br /> 128 140 Clay APN Book Page Parcel _ <br /> 140 160 Sand Township Range Section <br /> 160 2461 Clay Latitude I I I <br /> 246 248 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 248 258 Clay LOCATION SKETCH ACTIVITY (✓) <br /> NORTH x/ NEW WELL <br /> 258 267 Sand MODIFICATION/REPAIR <br /> 267 278 Clay —Deepen <br /> 278 285 Sand —other(Specify) <br /> 285 295 Clay — DESTROY(Describe <br /> 295 305 Coarse Sand Procedures and Materials <br /> 305 325 Clay Under"GEOLOGIC LOG' <br /> PLANNED USES() <br /> WATER SUPPLY <br /> t~p H Domestic— Public <br /> Irrigation _ Industrial <br /> MONITORING— <br /> 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 COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STATIC <br /> WATER LEVEL 106 (Ft.)&DATE MEASURED 10/31!2018 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 325 (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 310 (Feet) Mav not be representative o a well's long-term yield. <br /> DEPTHCASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE PORE- <br /> HOE aE —!L FROM SURFACE TYPE <br /> DIA• MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) GRADE DIAMETER OR WALL IF ANY MENT TONI FILLFILTER PACK <br /> Ft. to Ft. (Inches) THICKNESS (inches) Ft. to Ft. ✓ ✓ ✓ (TYPE/SIZE) <br /> (_) U <br /> 0 290 12 <br /> 290 3101 1212 310 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 /> — 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 /> IL 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 />