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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 2 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 94534 NO.e0372199 <br /> Date Work Began 4/19/2019 Ended4/22/2019 LATITUDE LONGITUDE <br /> Local Permit Agency Envirnnmental Health <br /> Permit No. wp0039487 Permit Date 4/2/2019 APNIFRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL HORIZONTAL ANGLE (SPECIFY) Name John Kelly <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 32 Club Dr <br /> FA DESCRIPTION Fairfield CA 94534 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 2 Top SOIII d LL LOCATION <br /> Address 12690 E. Fairchi d n <br /> 2 40 Clay Cit,Stockton CA 95215 <br /> 40 41 Sand <br /> County San Joaquin <br /> 41 1381 Clay APN Book Page Parcel <br /> 138 146 Sand Township Range Section <br /> 146 170 Clay Latitude I 1 1 <br /> 170 188 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 188 204 Clay LOCATION SKETCH ACTIVITY (✓) <br /> NORTH __v/_ NEW WELL <br /> 204 213 Sand <br /> MODI <br /> 213 FICATIONIREPAIR 257 Clay —Deepen <br /> 257 265 Sadn —other(specify) <br /> 265 278 Clay <br /> DESTROY (Describe <br /> 278 288 Fine Sand Procedures and Materials <br /> 288 292 Sand <br /> Under"GEOLOGIC LOG' <br /> >L) <br /> 292 299 Gravel PLANNED USES( <br /> WATER SUPPLY <br /> 299 313 Clay v~i Domestic— Public <br /> 313 318 Shale Irrigation _ Industrial <br /> 318 345 Clay MONITORING— <br /> TEST WELL— <br /> 345 350 Sand ATHODIC PROTECTION_ <br /> 350 447 Shale HEAT EXCHANGE- <br /> 447 448 Sand DIRECT PUSH- <br /> 448 497 Shale INJECTION— <br /> VAPOR EXTRACTION— <br /> 497 499 Sand SPAR <br /> 499 518 Shale SOUTH REMEDIATION 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 132 (Ft.)&DATE MEASURED 4/22/2019 <br /> TOTAL DEPTH OF BORING 518 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH <br /> TOTAL DEPTH OF COMPLETED WELL 360 (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> (Feet) Mav not be representative o 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 w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. to Ft. (Inches) g o a GRADE DIAMETER OR WALL IF ANY MENT TON <br /> FILL FILTER PACK <br /> m LL (Inches) THICKNESS (Inches) Ft. to Ft. ✓) (✓) �) (TYPE/SIZE) <br /> 0 200 21 v PLASTIC 12 200 0 56 <br /> 200 220 .045 56 360 ✓ GRAVEL <br /> 220 240 PLASTIC 12 200 <br /> .045 <br /> 280 PLASTIC 12 200 <br /> ATTACHMENTS (s ) 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,FI R CORPORATION) (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 Alber Modesto CA 95357 <br /> — Other ADDRESS CITY <br /> STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 05/02/19 668622 <br /> WELL DRIL AUTHORI D REP SENTATI DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />