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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO N T FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 1 of 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95320 No,e0372207 <br /> Date Work Began 5/10/2019 Ended5/13/2019 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental HFalth <br /> Permit No. wP0039528 Permit Date 4/22/2019 APNrrRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) –+L VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Dan Gust <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address_17597 Beeler Rd <br /> SURFACEDESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address <br /> 55 Sand ELL LOCATIO <br /> Address_17597 Beeler R <br /> City Escalon CA 95320 <br /> 55 87 Clay County San Joaquin <br /> 87 921 Sand APN Book Page Parcel <br /> 92 1651 Shale Township Range Section <br /> 165 215 Clay Latitude l 1 1 <br /> 215 228 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 228 232 Shale LOCATION SKETCH ACTIVITY ) <br /> 232 235 Sand NORTH NEW WELL <br /> 235 244 Clay MODIFICATION/REPAIR <br /> —Deepen <br /> 244 250 Sand —other(specify) <br /> 250 255 Clay <br /> 255 261 Sand — DESTROY (Describe <br /> Procedures and Materials <br /> 261 264 Clay Under"GEOLOGIC LOG' <br /> 264 268 Sand PLANNED USES(.6) <br /> WATER SUPPLY <br /> 268 274 Clay ~it _v/ Domestic— Public <br /> 274 280 Sand — Irrigation — Industrial <br /> 280 300 Clay MONITORING— <br /> TEST WELL— <br /> ATHODIC PROTECTION_ <br /> HEAT EXCHANGE— <br /> DIRECT PUSH— <br /> INJECTION— <br /> VAPOR EXTRACTION— <br /> SPARGING— <br /> SOUTH REMEDIATION_ <br /> Rlustmte or Describe Distance of Well from Roads, Buildings, <br /> Fences,Rivets,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 (Ft.)BELOW SURFACE <br /> DEPTH OF STATC <br /> WATER LEVEL (Ft.)&DATE MEASURED 5/13/2019 <br /> TOTAL DEPTH OF BORING 300 ESTIMATED YIELD • (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLE'T'ED WELL280 _(Feet) I May not be representative o a well's lon -term Yield. <br /> DEPTH CASING <br /> ( ) ANNULAR MATERIAL <br /> FROM SURFACE - DEPTH <br /> HOLE TYPE ✓) FROM SURFACE TYPE <br /> DIA. Y w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. to Ft (Inches) U J GRADE DIAMETER OR WALL IF ANY ME NT TONI FILL FILTER PACK <br /> (Inches) THICKNESS (Inches) Ft, to Ft. (TYPE/SIZE) <br /> 0 260 11 <br /> 260 280 RAVEL <br /> F-_ <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 R CORPORATION) (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 Albers Rd 1 1.6 Modes CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATFACH ADDITIONAL INFORMATION,IF IT EXISTS Signed 06/11,119 668622 <br /> WELL DRILLERrAUTHORI. REP, ENTATIVE r DATE SIGNED C-57 LICENSE NUMBER <br /> DWR198REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONtJCUTIVELY NUMBERED FORM <br />