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1 <br /> ;'?T'R{PLICATE STATE OF CALIFOR>`TIA � DWR USE ONLY — DO NOT FILL IN <br /> Owner's Copy v-/ELL COMPLETION REPORT . <br /> Page,1 Of I - Refer to Instruction Pamphlee STATE WELL NO.t STATION NO. <br /> Owner's Well No. 95209 N°'736727 <br /> ❑ <br /> Date Work Began 7117101 Ernded7120101 LATITUDE LONGITUDE <br /> Local Permit Agency <br /> Permit No. 26733 Permit Date 7112/01 APNITRSlOTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -sem VERTICAL —HORIZONTAL — ANGLE _{SPECIFY} Name Earl Sellers <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 10818 Elk Horn Dr. F <br /> SURFACE DESCRIPTION Stockton --CA-95209 <br /> Ft, to Ft. Describe material, grain, size, color, etc. CITY - STATE ZIP <br /> 01 6,Soil WELL LOCATION <br /> 6' 10`Sand Address 10979 Mickey 6rove_Rd- <br /> 10' 60Clay City Stockton CA <br /> 60 65 Sand CountySan Joaquin _ <br /> APN Book Page Parcel <br /> 65; 70 Clay Township Range Section <br /> 70; 74�Sand Latitude , , <br /> 741 85,Clay DEG. MIN. SEC. DEG. I MIN. SEC, <br /> 85; 89,,Sand — LOCATION SKETCH—ACTIVITY L✓} <br /> 89; 135 Clay NORTH ♦� NEW WELL <br /> 1351 140'Sand MODIFICATIONlREPAIR <br /> Deepen <br /> 1401 175 Clay Other(spacify) I <br /> 1751 181 Sand <br /> DESTROY(Oescribe <br /> 181 I 190 Clay Procedures and Materials <br /> 190, 195,Sand Under"GEOLOGIC LOG" <br /> 195 210 ClayPLANNED USES(-) <br /> a WATER SUPPLY <br /> 210 212 3 Sand r✓ Domestic_ Public <br /> 212 222 f Clay Irrigation Industrial <br /> 222' 224 1 Sand MONITORING— <br /> TEST WELL <br /> 224 2551 1 Clay ATHODIC PROTECTION- <br /> 251 : <br /> ROTECTION_251I 252 Sand HEAT EXCHANGE i <br /> 2521 260, Clay DIRECT PUSH_ <br /> 260 261 ,Sand INJECTION <br /> 261 279 Clay VAPOR EXTRACTION <br /> SPARGING_ , <br /> 279' 286' Sand fair SOUTH <br /> 1 11hra9rate or Describe Disranre of Well from Roads, Buildings, REMEDIATION <br /> 2861 2950 I Clay Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY) <br /> necessary. PLEASE BE ACCURATE & COMPLETE. <br /> WATERLEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE 1 <br /> DEPTH,OF STAT <br /> WATER LEVEL_ (Ft.)&DATE MEASURED 7]20]0] <br /> TOTAL DEPTH OF SORil iG 295 _ ESTIMATED YIELD (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL290 (Feet) May 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. 1 w o_ MATERIAL] INTERNAL GAUGE SLOTSIZE ' <br /> (Inches) Z BEN- <br /> Lu ZO J GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL F$LTER PACK <br /> Ft. to Ft. m �, v (Inches) THICKNESS (Inches) Ft. to Ft. [TYPESIZE) <br /> 0, 270 12 PLASTIC 6 160 0 200 <br /> 270;- 290 ✓ .045 200 290 GRAVEL ' <br /> 1 <br /> , <br /> ATTACIrME.NTS ( r ) 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,O ORPORATION) (TYPED OR PRINTED) ? <br /> SolltWater Chemical Analysis 119 Albers Rd. Modesto CA 95357 <br /> Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL 1NFORMATION,iF ITEXISTS. Signed 07/25101 668622 <br /> WELL DRILLERlAUTHORIZED REPRESENTATIVE DATE SIGNED C-51 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM I <br /> I <br /> I <br /> I <br />