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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 NO. <br /> Owner's Well No. 95337 No.e0369885 11 11 <br /> Date Work Began 11/19/2018 Ended11/21/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I I I I I I I__I_ <br /> Permit No. wp0038906 Permit Date 10/18/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) V VERTICAL —HORIZONTAL — ANGLE —(SPECIFY) Name Steve&Amber Brown <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 765 Grafton Rd <br /> ACEDESCRIPTION Manteca CA 95337 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 13715 Castle R IVELL LOCATIO <br /> 3 15 Sand City Manteca CA 95337a <br /> 15 31 Clay <br /> County San Joaquin <br /> 31 72 Sand APN Book Page Parcel <br /> 72 110 Clay Township Range Section <br /> 110 127 Sand Latitude I 1 I <br /> 127 150 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 150 160 Shale LOCATION SKETCH ACTIVITY (✓) <br /> NORTH -I' NEW WELL <br /> 160 173 Clay <br /> 173 190 Sand MODIFICATION/REPAIR <br /> —Deepen <br /> 190 194 Clay —other(Specify) <br /> 194 195 Sand <br /> escribe <br /> 195 240 Clay — PrEocceeddurres(and Materials <br /> Under"GEOLOGIC LOG" <br /> PLANNED USES() <br /> WATER SUPPLY <br /> ~ Domestic— Public <br /> LQ Irrigation _ Industrial <br /> ul 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 R ell 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 <br /> (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 200 (Feet) I May not be representative o a well's long-term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE B 0 E :7YPE FROM SURFACE TYPE <br /> DIA. Y w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z it p a GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft. to Ft. m � v (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) U (IYPE/SIZE <br /> 0 180 11 v PLASTIC 6 200-___ 0 100 <br /> 180 200 4 V <br /> ATTACHMENTS (y) 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,FIRMA,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,IFITSaSTS. 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 />