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QUADRUPLICATE STATE, OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT I I I I I I I I. <br /> Page I of I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95236 NO.e0343623 1111 = 01 ❑ <br /> Date Work Began 5/12/2017 Ended6/1/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Fnvirnnmental Health <br /> Permit No. Permit Date <br /> 75273 7/20/2016 APN/TRS/OTHER <br /> — GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL HORIZONTAL — ANGLE —(SPECIFY) Name Shelton Rd LLC <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 18600 Tobacco Rd <br /> SURFACEDESCRIPTION Linden CA 95236 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 2 Top Soil Address 26803 E. Flood <br /> �LL LOCATION <br /> 2 13 Clay city Linden CA 95236 <br /> 13 35 Rocks and Gravel County San Joaquin <br /> 35 67 Clay <br /> 67 74 Sand APN Book Page Parcel <br /> Township Range Section <br /> 74 83 Clay Latitude 1 <br /> 83 88 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 88 143 Clay LOCATION SKETCH ACTIVITY (✓) <br /> 143 153 Sand NORTH NEW WELL <br /> MODIFICATION/REPAIR <br /> 153 169 Clay —Deepen <br /> 169 171 Black Sand —other(Specify) <br /> 171 188 Clay <br /> 188 190 Black Sand — °ocea res OY (Describe <br /> Materials <br /> Under"GEOLOGIC LOG' <br /> 190 193 Clay PLANNED 11SES(-r-) <br /> 193 213 Black Sand WATER SUPPLY <br /> U) <br /> 213 218 Clay ---/ Domestic_ Public <br /> 218 230 Blacl Sand Irrigation _ Industrial <br /> 230 250 Clay MONITORING— <br /> TEST WELL— <br /> 250 264 Black Sand ATHODIC PROTECTION- <br /> 264 300 Clay HEAT EXCHANGE- <br /> 300 310 Black Sand RECEIVE <br /> DIRECT PUSH— <br /> INJECTION— <br /> 310 332 Clay Blue VAPOR EXTRACTION <br /> 332 348 Fine Black Sand SPARGING_ <br /> 348 364 Bue Shale JAN 18 201 SOUTH REMEDIATION— <br /> !!lustrete or DescriAe Distance of We!!from Hnads. Buildings, <br /> 364 368 Black Sand ``11 Fences,Rivers,etc. and attach a map. Use additional paper if OTHER (SPECIFY)_ <br /> 368 396 Blue Shale E,N I IMN.N1 EN FAL ary. PLEASE BE ACCURATE & COMPLETE. <br /> 3961 415 Black Sand m-:i,A RTMEN I WATER LEVEL&YIELD OF COMPLETED WELL <br /> 415 460 Blue Clay DEPTH TO FIRST WATER (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STAT C 5/16/2017 <br /> WATER LEVEL �30 (Ft.)&DATE MEASURED <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 460 (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 420 (Feet) May not be representative of a well's long-term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOE TYPE �) FROM SURFACE TYPE <br /> DIA. x w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z w p o. GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft. to Ft. m U 0 LL (Inches) THICKNESS (Inches) FL to Ft. ✓ (✓) (✓) (TYPE/SIZE) <br /> 0 380 14 <br /> 380 420 100 420 GRAVEL <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> — Geologic Log 1,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 CORPORA T ON) (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119AIberssModesto CA 95357 <br /> — Other ADDRESS It 19 CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT IXISTS. Signed 06/01/17 668622 <br /> WELL DRI A T RIWCONSETIVEL? <br /> DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE N MBERED FORM <br />