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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 1 of 1 Rcfer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95366 NO.e0372169 ❑ <br /> Date Work Began 1/22/2019 Ended1/23/2019 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health <br /> Permit Permit No. w 0039214 it Date <br /> 1/18/2019 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(V) tet—VERTICAL HORIZONTAL ANGLE (SPECIFY) Name Jason Cho <br /> DRILLING ROTARY DEPTH FROM METHOD TARY FLUID Mud Mailing Address P.O. BOX 1101 <br /> S RFA E DESCRIPTION Ripon CA 95366 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 11263 E Allen 41ELL LOCATIO <br /> 3 37 Sand City Ripon CA 95366 <br /> 37 82 Clay CountySan Joaquin <br /> 82 97 Sand <br /> 97 120 Clay APN Book Page Parcel <br /> Township Range Section <br /> 120 150 Sand Latitude <br /> 150 217 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 217 221 Sand LOCATION SKETCH ACTIVITY ) <br /> 221 238 Clay NORTH NEW WELL <br /> MODIFICATION/REPAIR <br /> 238 245 Sand —Deepen <br /> 245 250 Clay —Other(Specify) <br /> 250 253 Sand&Gravel <br /> — DESTROY (Describe <br /> 253 264 Clay Procedures and Materials <br /> 264 272 Sand Under"GEOLOGIC LOG <br /> PLANNED USES() <br /> 272 286 Shale WATER SUPPLY <br /> F_ <br /> Q U) —A( Domestic Public <br /> Irrigation Industrial <br /> LLl MONITORING— <br /> TEST WELL— <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH— <br /> INJECTION <br /> VAPOR EXTRACTION— <br /> SPARGING— <br /> SOUTH REMEDIATION— <br /> Illustmte or Describe Distance of Well from Roads, Buildings, <br /> Fences,Rivers,etcand 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 61 (Ft.)&DATE MEASURED 1/23/2019 <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 286 (Feet) TEST LENGTH <br /> (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 280 (Feet) I Mav not be representative of a well's long-term yield. <br /> DEPTH BORE- DEPTH CASING(S) ANNULAR MATERIAL <br /> FROM SURFACE HOLETYPE V) FROM SURFACE TYPE <br /> DIA. t w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z w p °- GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft. to Ft. m v (Inches) THICKNESS (Inches) Ft. to Ft. <br /> (✓) �) (TYPE/SIZE) <br /> 0 260 11 PLASTIC 6 200 0 200 <br /> 260 280 .045 200 280 GRAVE <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,FIRM,OR CORPORATION) (TYPED OR PRINTED) <br /> SoillWater Chemical Analysis 119 Albers Rd Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> A7TACH ADDITIONAL INFORMATION,IF lT IXISTS. Signed 02/25/19 668622 <br /> WELL DRILLI♦R/AUTHORIZfI?RtPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT'CONSECUTIVELY NUMBERED FORM <br />