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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page I of I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95320 No.e0372181 <br /> Date Work Began 3/22/2019 Ended3/25/2019 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health <br /> Permit No. wp0038852 Permit Date 10/4/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -./-VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Patty Amador <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 30685 E. Lee Rd <br /> SURFACEDESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITE STATE ZIP <br /> 0 5 Sand Address 30399 Lee Rd WELL LOCATIO <br /> 5 13 Rocks City Escalon CA 95320 <br /> 13 33 Clay County San Joaquin <br /> 33 43 Gravel and Rocks APN Book Page Parcel <br /> 43 68 Clay Township Range Section <br /> 68 85 Sand Latitude I 1 1 <br /> 85 100 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 100 115 Gravel LOCATION SKETCH ACTIVITY (✓) <br /> NORTH -.V—" NEW WELL <br /> 115 139 Clay <br /> MODIFICATION/REPAIR <br /> 139 152 Sand —Deepen <br /> 152 200 Clay —other(Specify) <br /> 200 202 Sand <br /> — <br /> DESTROY(Describe <br /> 202 240 Clay Procedures and Materials <br /> Under"GEOLOGIC LOG" <br /> 24 251 Sand PLANNED USES(Z-)251 265 Clay WATER SUPPLY <br /> 265 266 Sand Domestic Public <br /> 266 282 Clay 3 �C Irrigation _ Industrial <br /> 282 284 Sand MONITORING— <br /> TEST WELL— <br /> 284 303 Clay ATHODIC PROTECTION- <br /> 303 307 Sand HEAT EXCHANGE- <br /> 307 318 Clay DIRECT PUSH- <br /> 318 378 Shale INJECTION— <br /> VAPOR EXTRACTION— <br /> 378 381 Sand SPARGING_ <br /> 381 460 Shale 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 STATIC <br /> WATER LEVEL 46 (Ft.)&DATE MEASURED 3/25/2019 <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 460 (Feet) TEST LENGTH <br /> TOTAL DEPTH OF COMPLETED WELL300 Feet LENGTH—(Hrs.) TOTAL DRAWDOWN_ (FL) <br /> (Feet) M not be representative o a well's loo -term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE -' FROM SURFACE TYPE <br /> DIA. 1 w a MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z w 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 /> 0 140 171/2 PLASTIC 10 9no 1 0 6 ✓ <br /> 140 160 v, .045 <br /> 160 200 <br /> 200 300 ✓ <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 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. I fined 03/25/19 668622 <br /> WELL DRILLER/AUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 189 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />