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QUADRUPLICATE STATE OF CALIFORNIA DWR VSE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 1 of I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95215 NO.e0345025 <br /> Date Work Began 6/15/2017 Ended6/16/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I I I I I I TI I I <br /> Permit No. Permit <br /> 77687 Date 6/9/2017 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) ✓—VERTICAL HORIZONTAL ANGLE —(SPECIFY) Name Moormans Water Systems <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 2120 Wilcox Rd <br /> SURFACEDESCRIPTION Stockton CA 95215 <br /> Ft. to Ft. Describe material, grain, sue, color, etc. CITY �E STATE ZIP <br /> 0 3 Top Soil 4338 N. Homer Ktl LL LOCATIO <br /> 3 58 ClayAddress <br /> City Stockton CA 95215 <br /> 58 67 Sand CountySan Joaquin <br /> 67 86 Clay APN Book Page Parcel <br /> 86 93 Gravel Township Range Section <br /> 93 157 Clay Latitude I 1 1 <br /> 157 162 Gravel DEG. MIN. SEC. DEG. MIN. SEC. <br /> 162 228 Clay LOCATION SKETCH ACTIVITY (✓) <br /> 228 230 Sand NORTH - NEW WELL <br /> 230 266 Clay <br /> MODIFICATION/REPAIR <br /> Deepen PAIR <br /> 266 275 Sand —Other(Specify) <br /> 275 2951 Clay <br /> — DESTROY (Describe <br /> Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> PLANNED USES(.(-) <br /> WATER SUPPLY <br /> r~q --k/– Domestic— Public <br /> Q Irrigation Industrial <br /> LLI MONITORING— <br /> TEST WELL— <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH_ <br /> INJECTION— <br /> VAPOR EXTRACTION— <br /> SPARGING <br /> SOUTH REMEDIATION— <br /> Illustrate or Describe Distance of Wel/from Roads, Buildings, <br /> 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 /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> DEPTH OF STAT, 6/16/2017 <br /> WATER LEVEL (Ft.)&DATE MEASURED <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 295 (Feet) TEST LENGTH <br /> (Hrs.) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED wELL280 (Feet) May not be representative o a well's Ion -term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE 8 O E aTY�PE .:�. FROM SURFACE TYPE <br /> DIA. MATERIAL J INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft to Ft. (Inches) THICKNESS (Inches) Ft. to Ft. ✓) (✓) (✓) (TYPE/SIZE) <br /> 0 260 105/8 <br /> 260 280 RAV L <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> — Geologic Log 1,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 I (TYPE O P <br /> — SoiltWater Chemical Analysis 119 Ibers R /A Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IFITD(ISTS. 11 Signed 07/10/17 668622 <br /> WELL DRILLER/AUTHORIZED RESEN IVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR198REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />