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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FELL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page I of 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95336 No.e0333983 ❑�D El <br /> Date Work Began 1/7/2017 Endedl/9/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health — I I I I III 1 11 I I I <br /> Permit No. Permit Date <br /> 76506 12/28/2016 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(V) _siL VERTICAL _HORIZONTAL ANGLE —(SPECIFIC Name Enc Isbell <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 16772 S.Austin Rd <br /> SURFACE DESCRIPTION Manteca CA 95336 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 10:Sand Address 16784 S.Austin)WL <br /> LOCATIO <br /> 10 15;:Clay Cit,Manteca CA 95336 <br /> 15; 20 i Sand CountySan Joaquin _ <br /> 20:__. 57.:Clay APN Book Page Parcel _ <br /> 57i 60:Sand Township Range Section <br /> 60: go:Clay Latitude <br /> go: <br /> 93:!Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 93: 110 i Clay LOCATION SKETCH NEW WELL ACTIVITY (✓) <br /> 110: 134:Sand <br /> MODIFICATION/REPAIR <br /> 134:: 143 Clay Deepen <br /> 143i 145;:Sand —other(specify) <br /> 145: 149:Clay <br /> OY <br /> 149 i 152 i Sand — Pour eod Meienals <br /> Under"GEOLOGIC LOG' <br /> 1521 157iClay PLANNED USES(z) <br /> 157:. 1601 Sand WATER SUPPLY <br /> 160 194:Clay , <br /> Domestic— Public <br /> 194 i 205:Sand IrrigationIndustrial <br /> 205: 225 ClayMONITORING--- <br /> TEST WELL— <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH_ <br /> INJECTION — <br /> VAPOR EXTRACTION — <br /> SPARGING_ <br /> JAN 18 SOUTH REMEDIATION— <br /> -- Illustrate or Describe Distance of bell from Roads, Buildings, <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY) <br /> Et�LTH necessary. PLEASE BE ACCURATE & COMPLETE. <br /> nrn RT�1 F.NT WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft)BELOW SURFACE 1 <br /> DEPTH OF STATIC <br /> WATER LEVEL-46 (Ft)&DATE MEASURED 1/9/2017 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE_ <br /> TOTAL DEPTH OF BORING 225 (Feet) TEST LENGTH- -._(Hrs.) TOTAL DRAWDOWN____ (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL 215 (Feet) May not be representative o a well's lon -term yield. <br /> DEPTH BORE- CASING(S) ANNULAR MATERIAL <br /> DEPTH <br /> FROM SURFACE HOLE TYPE ✓ FROM SURFACE TYPE <br /> DIA Y w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN <br /> (Inches) Z W p!)LL <br /> a GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft to Ft. to v (Inches) THICKNESS (Inches) Ft to Ft. 'J/`` ,✓ (TYPE/SIZE) <br /> m V1 <br /> Oi 195 11PLASTIC 6 200 0 100 <br /> 195: 215 5 100 215GRAVEL <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 IN <br /> — Geophysical Log(s) (PERSON,FIRM CORPORATI <br /> — Soil Water Chemical Analysis 11 Albers Rd Modesto A 95357 <br /> Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EMSTS Signed 01/18/17 668622 <br /> WELL GRILLER/AUTHORIZED RESE IVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />