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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 I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95320 No.e0372180 <br /> Date Work Began 3/11/2019 Ended3/13/2019 LATITUDE LONGITUDE <br /> Local Permit Agency Fnvimnmental Health <br /> Permit No. wp0039042 Permit Date 11/16/2018 1APN1rRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL —HORIZONTAL —ANGLE _(SPECIFY) Name Tim Boyd <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 17199 Carrolton Rd <br /> SURFACE DESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITE' STATE ZIP <br /> 0 3 Top Soil Address Wagner Rd WELL LOCATIO <br /> 3 6 Sand Cit,Escalon CA 95320 <br /> 6 30 1 Clay County San Joaquin <br /> 30 44 Sand APN Book Page Parcel <br /> 44 55 Clay Township Range Section <br /> 55 58 Sand Latitude r I <br /> 58 71 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 71 75 Sand LOCATION SKETCH ACTWITY L) <br /> 75 81 Clay NORTH --V—" NEW WELL <br /> 81 89 Sand MODIFICATION/REPAIR <br /> —Deepen <br /> 89 123 Clay —Other(specify) <br /> 123 139 Sand <br /> 139 141 Clay —P°roced Tres(Describe aterials <br /> 141 143 Sand Under"GEOLOGIC LOG' <br /> PLANNED USES() <br /> 143 164 Clay WATER SUPPLY <br /> 164 168 Sand (n Cn Domestic— Public <br /> 168 178 Clay Irrigation _ Industrial <br /> 178 193 Sand MONITORING— <br /> TEST WELL <br /> 193202 Clay ATHODIC PROTECTION- <br /> 202 208 Sand HEAT EXCHANGE- <br /> 208 215 Clay DIRECT PUSH- <br /> 215 217 Sand INJECTION— <br /> 217 230 Clay VAPOR EXTPARGING_ <br /> 230 236 Sand SOUTH REMEDIATION— <br /> !/lusvate or Describe Distance of Wel!from Roads, Buildings, <br /> 236 250 Clay Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)- <br /> 250 254 Sand necessary. PLEASE BE ACCURATE & COMPLETE. <br /> 254 263 Clay WATER LEVEL&YIELD OF COMPLETED WELL <br /> 263 273 Sand DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> 273 3101 Clay DEPTH OF STAT <br /> WATER LEVEL 4 (Ft.)&DATE MEASURED 3/13/2019 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 310 (Fcet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 280 (Feet) May not be representative o a well's lon -term vield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLEORE aTY.PE _!L FROM SURFACE TYPE <br /> DIA• MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) GRADE DIAMETER OR WALL IF ANY FILTER PACK <br /> MENT TONIT FILL <br /> Ft. to FL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) �) (TYPE/SIZE) <br /> 0 180 131/2 <br /> 180 280 5 50 280 GR EL <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 Logs) (PERSON FIRM,OF CORPORATION) (TYPED OR PRINTED) <br /> soilrwacer chemical Analysis 119 Albers Modesto CA 95357 _ <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IFITEXiSTS. sigma 03/25/19 668622 <br /> 11 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 />