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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For tCocal Requirements WELL COMPLETION REPORT <br /> Page 2 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 Environmental Health L -I I I I I I I I I I I._I__. <br /> Permit No. wp0039487 Permit Date 4/2/2019 APWTRS/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 Country Club Dr <br /> SURFACE DESCRIPTION Fairfield CA 94534_ <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 2 Top SoilvFI,L LOCATION <br /> Address 12690 E. Fairchd 1 n <br /> 2 40 Clay City Stockton CA 95215 <br /> 40 41 Sand County San Joaquin <br /> 41 138 Clay APN Book Page Parcel <br /> 138 146 Sand Township Range Section <br /> 146 170 Clay <br /> Latitude I r I I <br /> 170 188 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 188 204 Clay LOCATION SKETCH ACTIVITY ) <br /> 204 213 Sand NORTH NEW WELL <br /> 213 257 Clay MODIFICATION/REPAIR <br /> —Deepen <br /> 257 265 Sadn —other(Specify) <br /> 265 278 Clay <br /> 278 288 Fine Sand —Procedures(Describe erials <br /> 288 292 Sand <br /> Under"GEOLOGIC LOG'292 299 Gravel PLANNED USES()WATER SUPPLY <br /> 299 313 Clay w ; 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 SPARGING_ <br /> 499 518 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 (FL)BELOW SURFACE <br /> DEPTH OF STATIC <br /> WATER LEVEL 132 (FL)&DATE MEASURED 4/22/2019 <br /> TOTAL DEPTH OF BORING 518 ESTIMATED YIELD ' (GPM)& TEST TYPE _ <br /> (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 360 (Feet) May not be re resentattve of a well's long-term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE v') FROM SURFACE p <br /> DIA. Y w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. to Ft. (Inches) m U U a GRADE DIAMETER <br /> OR WALL IF ANY THICKNESS (Inches) Ft. to Ft. MENT TONI FILL FILTER <br /> to a ✓ (`i) l� <br /> 320 340 PLASTIC 12 2no 0 56 V <br /> 340 360 .045 56 360 GIR EL <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,FI OR CORPORATION) (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 Al be 7 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 05/02/19 66$622 <br /> WELL DRIL ER/AUTHORIZED RP ESENTA IVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE 15 NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />