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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT F7� 11i 1i Ili i <br /> Page 1 of 2 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95366 NO.e0372176 1111 1 =1 ❑ <br /> Date Work Began 2/28/2019 Ended3/1/2019 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health <br /> Permit No. wp0039184 Permit Date 1/11/2019 APNrFRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -./—VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name DePalma Farms <br /> DRILLING <br /> THOD ROTARY M Mailing Address 18666 E. Hwy 120 <br /> SURFACEDEPTH FROM METHOD FLUID Mud g <br /> DESCRIPTION Ripon CA 95366 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 19002 S Carrolton*&LOCATIO <br /> 3 27 Sand City Ripon CA 95366 <br /> 27 631 Clay CountySan Joaquin <br /> 63 85 Sand <br /> 85 95 Clay APN Book Page Parcel <br /> Township Range Section <br /> 95 114 Sand Latitude I 1 1 <br /> 114 126 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 126 147 Sand LOCATION SKETCH ACTIVITY (✓) <br /> NORTH -.V—" NEW WELL <br /> 147 167 Clay MODIFICATION/REPAIR <br /> 167 173 Sand —Deepen <br /> 173 175 Clay —Other(Specify) <br /> 175 180 Sand <br /> — DESTROY(Describe <br /> 180 184 Clay Procedures and Materials <br /> 184 190 Sand Under"GEOLOGIC LOG' <br /> PLANNED USES() <br /> 190 192 Clay WATER SUPPLY <br /> 192 205 Sand W ~ Domestic— Public <br /> Wustrial <br /> 3 Q <br /> 205 214 Clay LLJ -Z Irrigation <br /> 214 217 Sand MONITORING— <br /> TEST WELL— <br /> 217 241 Clay ATHODIC PROTECTION- <br /> 241 247 Sand HEAT EXCHANGE- <br /> 247 2651 Clay DIRECT PUSH_ <br /> 265 267 Sand INJECTION— <br /> 267 268 Clay VAPOR EXTRACTION — <br /> SPARGING— <br /> 268 274 Sand and Gravel SOUTH REMEDIATION <br /> Illustrate or Describe Distance of Well from Roads, Buildings, <br /> 274 300 Shale Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)- <br /> 300 320 Sand and Gravel netemary. PLEASE BE ACCURATE & COMPLETE. <br /> 320 341 Shale WATER LEVEL&YIELD OF COMPLETED WELL <br /> 341 344 Sand DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> 3441 353 Shale DEPTH OF STAT <br /> 353 356 Sand WATER LEVELS (Ft.)&DATE MEASURED 3/1/2019 <br /> TOTAL DEPTH OF BORING 375 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 360 (Feet) May not be representative of a well's long-term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓ FROM SURFACE TYPE <br /> DIA. Y 11ZJ a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> PAC <br /> Ft. to Ft. (Inches) m U LL GRADE DIAMETE(in(inches)R THICKNESS (Inches) Ft, to Ft. MENT TOR WALL IF ANY SIT F-L (TYPFR./SIZ)K <br /> 0 240 21 PLASTIC 12 2no 50 V/ <br /> 240 360 V <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) (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. Signed 03/19/19 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 />