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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 I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95337 No.e0369884 <br /> Date Work Began 11/18/2018 , Ended1l/21/2018_ LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I I I I I I I I I I <br /> Permit No. wp0038904 Permit Date 10/18/2018 APN/rRs/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(2) VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Tony Thompson <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 765 Grafton St <br /> DESCRIPTION Manteca CA 95337 <br /> Ft. to R. Describe material grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top SoilAddress 13727 Castle RCFELL LOCATIO <br /> 3 54 Sand City Manteca CA 95337 <br /> 54 72 Clay CountySan Joaquin <br /> 72 89 Sand <br /> 89 117 Clay APN Book Page Parcel <br /> Township Range Section <br /> 117 131 Shale Latitude I I i <br /> 131 135 Clay DEG. MIN. SEC. DEG, MIN. SEC. <br /> 1351 141 Sand LOCATION SKETCH ACTIVITY (v) <br /> Sand <br /> NORTH IL NEW WELL <br /> 141 169 MODIFICATION/REPAIR <br /> 169 171 Sand —Deepen <br /> 171 175 Clay —other(specify) <br /> 175 189 Sand <br /> DESTROY 189 240 Clay Procedures escribe aDnd Materials <br /> Under"GEOLOGIC LOG" <br /> PLANNED USES() <br /> WATER SUPPLY <br /> N�J Domestic Public <br /> 5 ¢ Irrigation _ Industrial <br /> > LLJ 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 44 (Ft.)&DATE MEASURED 11/21/2018 <br /> ESTIMATED YIELD " (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 240 (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 200 (Feet) May not be representative o a well's loo -term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BOE TYPE ✓ FROM SURFACE TYPE <br /> DIA. Y w o. MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z w p o GRADE DIAMETER OR WALL IF ANY MENT TONI FILL FILTER PACK <br /> Ft. to Ft. m L) v LL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) �) (TYPE/SIZE) <br /> 0 180 11 <br /> 180 200 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 /> — SoiVWater Chemical Analysis 119 Albers Rd: Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT ExISTS. Signed 11/30/18 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 />