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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 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 94578 NO.e0372203 <br /> Date Work Began 4/29/2019 Ended5/9/2019 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health 171 1 1 1 1 1 1 1 1 1 1 <br /> Permit No. wp0039243 Permit Date 1/30/2019 APN/rRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -/—VERTICAL HORIZONTAL ANGLE (SPECIFY) Name Silvino Rodrigues <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 2193 Lomita Dr <br /> SURFACE DESCRIPTION San Leandro CA 94578 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 29924 Hwy 120 WELL LOCATION <br /> 3 33 Sand Cin,Escalon CA 95320 <br /> 33 75 Clay County San Joaquin <br /> 75 82 1 Sand APN Book Page Parcel <br /> 82 145 Clay Township Range Section <br /> 145 148 Sand Latitude I <br /> 148 163 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 163 166 Sand LOCATION SKETCH ACTIVITY (✓) <br /> NORTH __V" NEW WELL <br /> 166 193 Clay <br /> MODIFICATION/REPAIR <br /> 193 195 Sand —Deepen <br /> 195 208 Clay —Other(Specify) <br /> 208 229 Sand <br /> 229 235 Shale — Procedures(Da Materials <br /> 235 243 Sand Under"GEOLOGIC LOG" <br /> 243 255 Shale PLANNED USES() <br /> WATER SUPPLY <br /> F_ F- Domestic— Public <br /> Q Irrigation Industrial <br /> ul MONITORING <br /> — <br /> TEST WELL <br /> ATHODIC PROTECTION_ <br /> HEAT EXCHANGE— <br /> DIRECT PUSH— <br /> INJECTION— <br /> VAPOR EXTRACTION— <br /> SPARGING— <br /> 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 1 <br /> DEPTH OF STATIC <br /> WATER LEVEL 92 (Ft.)&DATE MEASURED 5/19/2019 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 255 (Feet) TEST LENGTH <br /> (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 255 (Feet) Mav not be representative of a well's long-term yield. <br /> DEPTH BORE- CASING(S) ANNULAR MATERIAL <br /> DEPTH <br /> FROM SURFACE HOLE TYPE ") FROM SURFACE TYPE <br /> DIA. Y w o- MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z w o o_ GRADE DIAMETER OR WALL IF ANY FILTER PACK <br /> Ft. to Ft. m c�.t 0 �_ (Inches) THICKNESS (Inches) Ft. to Ft. MENT TONIT FILL (TYPEISIZE) <br /> in <br /> 0 215 11 <br /> 215 255 100 255 AVEL <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,F ,OR CORPORA ION),(TYPED PRINTED) <br /> — Soil/Water Chemical Analysis 119 RMndesto CA Ode95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT DCISTS. Signed 05/30/19 668622 <br /> WELL DRILLE 01 ITH11-17M REPRE#NTATIVE1 DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />