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QUADRUPLICATE STATE OF CALIFORNIASE ONLY — OO NOT FI_ IN <br /> For Local Requirements WELL COMPLETION REPORT 71 Dim I <br /> Page 1 of 1 Refer fa 1n.Vracrinn Pumph(et STATE WELL NO.I STATION N0. <br /> Owner's Well No. 95366 No e0348025 I I DO <br /> Date Work Began 7/13/2017 Ended!/142017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health <br /> Permit No. WP0036801 Permit Date 7/102017 APNITRSAYTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(4) -V—VERTICAL —HORIZONTAL —ANGLE _(SPECIFY) Name Jose Villanuava <br /> DRILLING NARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 18396 S.Wagner Rd <br /> DESCRIPTION Ripon CA 95366 <br /> FL m Ft. Describe material, grain, see, Calor, etc. CITY STATE ZIP <br /> —OF 3 1 Top Soil wrW LOCATIO <br /> 3 5 Hard Pan Address 178Wanner <br /> 5 Sand and City Ripon CAA 955 366 <br /> 8 28 County San Joaquin <br /> 28 33 Sand APN Book Page Parcel <br /> 33 67 Clay Township Range Section <br /> Latitude I I I <br /> 67 69 Sand DEG. MIN. SEC. DEG. MIN, SEC, <br /> 69 78 Clay LOCATION SKETCH ACTIVrrY (✓) <br /> 78 88 Sand NORTH -AL NEW WELL <br /> BS 124 Clay MODIFICATIONmEPAIR <br /> —Deepen <br /> 124 132 Sand —olher(SW4) <br /> 132 157 Clay <br /> 157 158 Sand — DESTROY;(�ilea, <br /> Urge'GEOLOGIC L <br /> 158 200 Clay PLANNED USES(z) <br /> 200 206 Sand WATER SUPPLY <br /> 206 209 Clay N y Domestic— Pubic <br /> 209 216 Sand Irligaton ImJusmel <br /> 216 245 Clay MONITORING <br /> TEST247 Sand TEST WELL— <br /> ATHODIC PROTECTION- <br /> 247 275 Clay HEAT E%CHANGE- <br /> 275 275 Sand DIRECT PUSH_ <br /> 276295 Clay INJECTION— <br /> 295 299 Sand VAPOR EXTRACTION <br /> SPARGING- <br /> 299 307 Clay ewrr u. 1r A WmmOafW/I mm HaaAv, RUI ng, REMEDIATION- <br /> 307 308 Sand Fvcv,Riven,ac.sM Mtach•map. Use eddiu paper If OTHER(SPECIFY)_ <br /> eamry.PLEASE BE ACCURATE & COMPLETE <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (FL)BELOW SURFACE 1 <br /> DEPTHOF STATj <br /> WATER � <br /> WATER LEVEL JSP(FL)8 DATE MEASURED 7/142017 <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 308 (Feet) <br /> TOTAL DEPTH OF COMPLETED WELL255 TEST LENGTH ats TOTAL DRAWDOWN_ (Fl.) <br /> (Fee) M not be re resentatrve o a welts Ion—tem yield. <br /> DEPTH CASING(S) DEPTH <br /> MATERIAL <br /> FROM SURFACE HOLETYPE FROM SURFACE TYPE <br /> DW. z w g MATERIAL INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. la FL (lades) m m LL GRADE DIAMETER) OR WALL THICKNESS IFANY inrnes) Fl m Ft MENi Tyj `N; F� (TYPMIM)K <br /> 0 200 14 <br /> 200 220 -045 100 255 GRAVEL <br /> 220 235 <br /> 235 255 <br /> ATTACHMENTS (�r) CERTIFICATION STATEMENT <br /> — GODOW Log I,are urWenigned,celify that this IepoM1 Is complete and act mite to me Desi M my isv Nwge aM belief. <br /> _ WOO Comm w D.9m. NAME MASELLIS DRILLING INC <br /> — Geoyryeical Logs) (PERSON,FIR OR CORPORA ) (TYPED R PRINT€0) <br /> — So1AYater Chemica' Ancyeis <br /> e <br /> Dene ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF ITiWSTS. S9rlaa 07124(17 668622 <br /> WELL DRI A ES ATNE DATE SIGNED C57 LICENSE NUMBER <br /> D"as REV.11-97 IF ADDITIONAL SPACE IS NEEDED.USE N ONSEC LY NUMBERED FORM <br />