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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 WELL NO./STATION NO. <br /> Owner's Well No. 95336 No.w0369883 ❑ <br /> Date Work Began 11/21/2018 , Ended11/21/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Emtironmenatl Health <br /> Permit No. wp0039044 Permit Date 11/16/2018 APN/rRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Carlos Tovar <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 2193 Capistrano Ave <br /> SURFACEDESCRIPTION Manteca CA 95336 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITE' STATE ZIP <br /> 0 4 Top Soil Address 12776 French Camp KtlOCATIO <br /> 4 73 Clay City Manteca CA <br /> 73 83 Sand County San Joaquin <br /> 83 110 Clay <br /> APN Book Page Parcel <br /> 110 118 Sand and Gravel Township Range Section <br /> 118 148 Clay Latitude i 1 1 <br /> 148 151 Gravel DEG. MIN. SEC. DEG. MIN. SEC. <br /> 151 1551 Clay LOCATION SKETCH ACTMTY (✓) <br /> 155 163 Sand NORTH --V—" NEW WELL <br /> EPAIR <br /> 163 228 Clay MODIFICATDeepen <br /> 228 230 Sand —other(Specify) <br /> 230 231 Clay — DESTROY (Describe <br /> 231 232 Sand Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> 232 265 Clay PLANNED USESO <br /> WATER SUPPLY <br /> H Z Domestic— Public <br /> Q Irrigation Industrial <br /> u] 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 STATLC$ <br /> WATER LEVEL `j (Ft.)&DATE MEASURED 11/21/2018 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 265 (Feet) TEST LENGTH <br /> (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 240 (Feet) May not be representative o a well's long-term yield. <br /> DEPTH CASING(S) ANNULAR MATERIAL <br /> FROM SURFACE B - DEPTH <br /> OE aE !-'L) FROM SURFACE TYPE <br /> DIA. MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> nches) GRADE DIAMETER OR WALL IF ANY MENT TONIT FILLFILTER PACK <br /> ir <br /> Ft. to Ft. (inches) THICKNESS (Inches) Ft to Ft. V—) C±0 <br /> C±0 (TYPE/SIZE) <br /> co,0 160 105/8 v PLASTIC 1; 200 0 108 <br /> 160 1801 1 045 108 240 GRA EL <br /> 180 220 V PLASTIC 200 <br /> 220 240 .045 <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), (TYPEb 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. Sgtted 11/29/18 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 />