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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. 95320 No.e0369875 <br /> Date Work Began 11/1/2018 Endedl l/2/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I I I I 1 I 7-1-L-1-1 <br /> I <br /> Permit No. wp0038934 Permit Date 10/29/2018 APNITRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) V VERTICAL _HORIZONTAL —ANGLE (SPECIFY) Name Ken Hill <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 18707 Von Glahn Rd <br /> SURFACEDESCRIPTION Escalon CA 95320 <br /> Ft. to FL Describe material grain, size, color, etc. CITY STATE ZIP <br /> 0 2 Top Soil — <br /> Address 18707 Von Glahn W LOCATIO <br /> 2 6 Sand City Escalon CA 95320 <br /> 6 23 Clay County San Joaquin <br /> 23 34 Sand APN Book Page Parcel <br /> 34 52 Clay Township Range Section <br /> 52 55 Sand Latitude I I I I <br /> 55 80 Cela DEG. MIN. SEC. DEG. MIN. SEC. <br /> 80 105 Sand LOCATION SKETCH ACTIVITY L) <br /> NORTH _3(_ NEW WELL <br /> 105 125 Clay <br /> 125 130 Sand MODIFICATION/REPAIR <br /> —Deepen <br /> 130 156 Clay —other(Specify) <br /> 156 163 Sadn <br /> DESTROY (Describe <br /> 163 170 Clay Procedures and Materials <br /> 170 178 Sand Under"GEOLOGIC LOG' <br /> PLANNED USES() <br /> 178 187 Clay WATER SUPPLY <br /> 187 193 Sand Domestic— Public <br /> 193 255 Clay Irrigation — Industrial <br /> 255 256 Sand MONITORING— <br /> TEST WELL— <br /> 256 261 Clay ATHIODIC PROTECTION- <br /> 261 269 Sand HEAT EXCHANGE- <br /> 269 275 Clay DIRECT PUSH_ <br /> 275 276 Sand INJECTION <br /> VAPOR EXTRACTION— <br /> 276 295 Clay <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 <br /> DEPTH OF STATg <br /> WATER LEVEL- (Ft.)&DATE MEASURED 11/2/2018 <br /> TOTAL DEPTH OF BORING 295 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL280 (Feet) Mav not be representative of a well's lon -term vield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓ FROM SURFACE TYPE <br /> DIA. y w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z p a GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> Ft. to Ft. m v (Inches) THICKNESS (Inches) Ft to Ft. (TYPE/SIZE) <br /> rn u- ✓ (✓) (.6 <br /> 0 260 12 pLAsTic r, 900 0 208 <br /> 260 280 .045 208 280 V, -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 /> WELL DRILLER/AUTHORIZED REPRESENTATIVE DATE SIGNED C57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />