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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 1 Refer to Instruction Pamphlet STATE WELLNO./STATION NO. <br /> Owner's Well No. 95320 No-e0369882 1111 111111 II -F-j[:] <br /> Date Work Began 11/12/2018 Endedl 1/14/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I III III I I I <br /> Permit No. wp0038996 Permit Date 11/7/2018 APNtrRS/OTHER - <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -/—VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Bob Rose <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 24958 Lone Tree Rd <br /> SURFACEDESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top SOII W L LOCATION <br /> 3 15 Shale Address 24958 Lone Tree <br /> City Escalon CA 95320 <br /> 15 37 Clay CountySan Joaquin <br /> 37 54 Sand APN Book Page Parcel <br /> 54 106 Shale Township Range Section _ <br /> 106 132 Sand Latitude I I , <br /> 132 163 Shale DEG. MIN. SEC. DEG. MIN. SEC. <br /> 163 221 Clay LOCATION SKETCH ACTIVITY (V) <br /> NORTH __v/_ NEW WELL <br /> 221 227 Sand <br /> 227 245 Clay MODIFICATION/REPAIR <br /> —Deepen <br /> 245 246 Sand —Other(Specify) <br /> 246 262 Clay <br /> DESTROY (Describe <br /> 262 265 Sand Procedures and Materials <br /> 265 283 Clay Under"GEOLOGIC LOG' <br /> 283 306 Black Sand PLANNED USES() <br /> WATER SUPPLY <br /> 306 313 ClayW y Domeatlo— Public <br /> 313 315 Sand — 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 Welt 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 STAT6C 11/14/2018 <br /> WATER LEVEL (Ft.)&DATE MEASURED <br /> TOTAL DEPTH OF BORING 315 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 3O0 (Feet) M not be representative o a well's lon -term field. <br /> DEPTH - DEPTH <br /> ANNULAR MATERIAL <br /> FROM SURFACE <br /> BORE <br /> OLE TYPE °> CASING( ) FROM SURFACE TYPE <br /> DIA. Z w Z g MATERIAL/ INTERNAL GAUGE SLOT SIZE <br /> DIAMETER OR WALL IF ANY CE- BEN- FILTER PACK <br /> (Inches) � O a GRADE MENT TONI FILL <br /> Ft. to Ft. mg v LL (Inches) THICKNESS (Inches) Ft. to Ft. (TYPE/SIZE) <br /> 0 280 11 <br /> 280 300 200 300 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 COR, RATION) (TYPED OR PRINTED) <br /> — SoilfWater Chemical Analysis 119 Albers Rd Modesto CA 95357 <br /> — Other ADDRESS CITY <br /> STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT IX/STS. Signed 11/29/18 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 />