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State of Califomia <br /> Well Completion Report <br /> Form DWR 188 Submitted 9124/2019 <br /> WCR2019-013498 <br /> Owner's Well Number Date Work Began 09/09/2019 Date Work Ended 09/20/2019 <br /> Local Permit Agency San.Joaquin County Environmental Health Department <br /> Secondary Permit Agency Permit Number 40037 Permit Date 09/03/2019 <br /> Well Owner(must remain confidential pursuant:to Water Code 13752) Planned Use and Activity <br /> Name Nancy Burroughs Activity New Well <br /> Mailing Address 20814 S.Carrolton Rd. Planned Use Water Supply Domestic <br /> City Ripon State CA Zip 95366 <br /> Well Location <br /> Address 17569 Campbell AVE APN 227-390-08 <br /> City Escalon Z 95320 County San.Joaquin Township 01S <br /> Latitude 37 48 7.8145 N Longitude -120 58 46.8357 W Range 09 E <br /> Section 33 <br /> Deg. Min. Sec. Deg. Min. Sec. Baseline Meridian Mount Diablo <br /> Dec.Lat. 37.8021707 Dec.Long. -120.9796766 Ground Surface Elevation <br /> Vertical Datum Horizontal Datum WGS84 Elevation Accuracy <br /> Location Accuracy Location Determination Method Elevation Determination Method <br /> Borehole Information Water Level and'Yiefd.ofCompieted Well .^ <br /> Orientation Vertical Specify Depth to first water (Feet below surface) <br /> Depth to Static <br /> Grilling Method Other-mud rotary Drilling Fluid Water Water Level 97 (Feet) Date Measured 09/20/2019 <br /> Total Depth of Boring 270 Feet Estimated Yield* (GPM) Test Type Air Lift <br /> Test Length (Hours) Total Drawdown (feet) <br /> Total Depth of Completed Well 270 Feet *May not be representative of a well's long term yield. <br /> Geologic Log-Free Form <br /> Depth from <br /> Surface Description <br /> Feet to Feet <br /> 0 3 topsoil <br /> 3 26 sand <br /> 26 33 clay <br /> 33 68 sand <br /> 68 76 clay <br /> 76 110 sand <br /> 110 180 clay <br /> 180 193 sand <br /> 193 230 clay <br /> 230 248 sand <br /> 248 264 clay <br /> 264 268 sand-coarse <br /> 268 270 clay <br /> Form DWR 188 rev. 12/19/2017 Page_L of 2 <br />