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'QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT Ellilililli <br /> Page 1 of 2 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95320 No.w0369889 ❑ <br /> Date Work Began 12/7/2018 Ended12/10/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Envimnmental Health <br /> Permit No. wp0038903 Permit Date 10/18/2018 APWrRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) v/ VERTICAL _HORIZONTAL —ANGLE —(SPECIFY) Name Brooks Bauer <br /> DRILLING ROTARY <br /> ROT <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 20592 Avers 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 22901 Skiff Rd WELL LOCATIO <br /> 3 62 Shale City Escalon CA 95320 <br /> 62 83 Sand CotmtySan Joaquin <br /> 83 93 Clay APN Book Page Parcel <br /> 93 97 Sand Township Range Section <br /> 97 108 Clay Latitude I I <br /> 108 112 Gravel DEG. MIN. SEC. DEG. MIN. SEC. <br /> 112 116 Clay LOCATION SKETCH ACTIVITY (v) <br /> 116 119 Sand NORTH --%/— NEW WELL <br /> MODIFICATION/REPAIR <br /> 119 140 Clay —Deepen <br /> 140 150 Gravel —Other(Specify) <br /> 150 196 Clay — DESTROY(Describe <br /> 196 221 Sand Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> 221 250 Shale PLANNED USES() <br /> 250 254 Black Sand WATER SUPPLY <br /> 254 285 Shale to Irrigation° i — Public al <br /> 285 291 Black Sand <br /> 291 311 Shale MONITORING- <br /> 311 <br /> ONITORING-311 316 Black Sand TEST WELL— <br /> ATHODIC PROTECTION- <br /> 316 327 Shale HEAT EXCHANGE- <br /> 327 329 Black Sand DIRECT PUSH_ <br /> 329 333 Shale INJECTION— <br /> VAPOR EXTRACTION— <br /> 333 334 Black Sand <br /> SPARGING— <br /> 334 340 Shale SOUTH REMEDIATION <br /> — <br /> 111ustmte or D-cribe Distance of Well from Roads, Buildings, <br /> 340 343 Sand Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)- <br /> 343 348 Clay necessary. PLEASE BE ACCURATE & COMPLETE. <br /> 348 350 Sand WATER LEVEL&YIELD OF COMPLETED WELL <br /> 350 365 Shale DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> 365 375 Sand DEPTH OF STATIC <br /> 375 380 Shale WATER LEVEL 125 (Ft.)&DATE MEASURED 12/10/2018 <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TEST LENGTH <br /> (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF BORING 460 (F ) <br /> TOTAL DEPTH OF COMPLETED WELL 440 (Feet) May not be representative o a well's long-term yield. <br /> DEPTHCASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HORS TYPE ✓) FROM SURFACE TYPE <br /> DIA. Y w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. to Ft. <br /> (Ind m m p a GRADE DIAMETER <br /> OR WALL IF TH CKNESS (Inches) Ft. to Ft. MENT TONIT FILL FILTER( SIZE)K <br /> to LL ✓ (�) (✓) _ <br /> 0 360 20 <br /> 360 440 .045 50 440 GRAVEL <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> — Geologic Log 1,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 .- YPED OR PRINTED) <br /> — SoiVWater Chemical Analysis 119 Albers Rd Modesto CA 95357 <br /> — Other ADDRESS - _ CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 12/17/18 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 />