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-T'RIPLICATE <br /> STATE OF CALIFORNIA — DWR USE ONLY — DO NOT FILL IN <br /> Owner's Copy YELL COMPLETION REPORT <br /> Page,I of 1 Refer to Insfmclion Pamphler STATE WELL NO.I STATION NO. <br /> Owner's Well No. 95209 No.736727FE <br /> Date Work Began 7117101 Ended7120101 LATITUDE ❑ LONGITUDE <br /> Local Permit Agency Public Healtb Services <br /> Permit No. 26733 Permit Date 7112101 APNITRSIOTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL _HORIZONTAL — ANGLE —(SPECIFY) Name Earl Sellers <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 10818 Elk Horn Dr. <br /> SURFACE DESCRIPTION Stockton CA 95209 <br /> Ft. to Ft. Describe malerial, grain, sue, color, etc. CITY STATE ZIP <br /> 0, 6,Soil WEej OCATIO <br /> 6' 10'Sand Address 10979 Mickey Grove hid. <br /> 10' 60'Clay City Stockton CA <br /> CountySan Joaquin <br /> 60, 65: Sand <br /> APN Book Page Parcel <br /> 65+ 701 Clay Township Range Section <br /> 70l 74 Sand Latitude <br /> 741 85,Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 85 89E.Saand LOCATION SKETCH ACTIVITY (`) <br /> 89 i 135 1 Clay NORTH __Y_" NEW WELL <br /> 135' 1401 Sand <br /> MODIFICATIONIREPAER <br /> Deepen <br /> 140 1.75 1 Clay Other(Specify) <br /> 175+ 181 Sand <br /> + - DESTROY(Describe <br /> 181 190 Clay Procedures and Materials <br /> 190, 195,Sand Under"GEOLOGIC LOG" <br /> 195, 210,Clay <br /> PLANNED USES(.) <br /> WATER SUPPLY <br /> 210! 212:Sand w F_ ✓ Domestic_ Public <br /> 212, 222 1 Clay Irrigation _ Industrial <br /> 222, 224 l Sand MONITORING- <br /> -.---- TEST WELL_ <br /> 224 251 Clay ATHODIC PROTECTION- <br /> 251: <br /> ROTECTION_251i 2662 i Sand HEAT EXCHANGE <br /> 252, 260, Clay DIRECT PUSH_ <br /> t. 260, 261 , Sand INJECTION— <br /> 261 : 279 Clay VAPOR EXTRACTION <br /> SPARGING_ <br /> 279 286 Sand fair SOUTH REMEDIATION <br /> 111nsrram or Describe Dislance of Well from Roadr, Brdldlng.r, <br /> 286, 295'5+Clay 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 /> r DEPTH-TO FIRST WATER (Ft.)BELOW SURFACE 1 <br />' i DEPTH OF STAT�L <br /> WATER LEVEL_`+� (FL)&DATE MEASURED 7/20101 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 295 (Fest) 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. x w ° MATERIAL 1 INTERNAL GAUGE SLOT SIZE <br /> CE- BEN- <br /> (Inches) Z 2p J GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft to Ft. m ,J v (Inches) THECKNESS (Inches) Ft, to Ft, (TYPEISSZE) <br /> (1) L) <br /> 0 270 12 PLASTIC 6 160 0 200 <br /> 270; 290 ✓ .045 200_' 290 V7 GRAVEL. <br /> IF <br /> ATTACHMENTS ( f ) CERTIFICATION STATEMENT <br /> — Geologic Log I,the undersigned,certify that this report]s 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,0 ORPORATION) (TYPED OR PRINTED) <br /> ____ Sciliwater Chemical Analysis 119 Albers Rd. r Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL 1NFORMATfON,IF IT EXISTS. Signed 07/25/01 668622 <br /> WELL❑RI3 lER1AUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR les REV.I1-97 1F ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> I , <br />