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QUADRUPLICATE STATE OF CALIFORNIADWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page I of I Refer to Instruction Pamphlet STATE WELLNO./STATION NO. <br /> Owner's Well No. 95320 NO.e0346005 I I I DDI <br /> Date Work Began 6/21/2017 Ended6/22/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health LI I I I I I I I I I <br /> P <br /> Permit No. -Permit Date <br /> 77713 6/13/2017 APNrrRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(!) V VERTICAL —HORIZONTAL — ANGLE —(SPECIFY) Name Larry Woltjer <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 19467 Sexton 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 20007 ZumwaltLL LOCATIO <br /> 3 4 Clay City Escalon CA 95320 <br /> 4 6 Hard Pan County San Joaquin <br /> 6 9 Sand <br /> APN Book Page Parcel <br /> 9 11 Clay Township Range Section <br /> 11 191 Sand Latitude I 1 <br /> 19 21 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 21 42 Sand LOCATION SKETCH ACTIVITY ) <br /> 42 60 Clay <br /> NORTH --%/— NEW WELL <br /> 60 73 Sand MODIFICATION/REPAIR <br /> —Deepen <br /> 73 108 Clay —Other(Specify) <br /> 108 118 Sand <br /> — DESTROY (Describe <br /> 118 155 Clay Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> 155 164 Sand PLANNED USES(-(-) <br /> 164 188 Clay WATER SUPPLY <br /> ~ <br /> 188 190 Sand Domestic Public <br /> W Industrial <br /> 190 197 Clay Irrigation — <br /> 197 198 Sand MONITORING— <br /> TEST WELL <br /> 198 200 Clay ATHODIC PROTECTION- <br /> 200 203 Sand HEAT EXCHANGE- <br /> 203 243 Clay DIRECT PUSH_ <br /> 243 244 Sand INJECTION— <br /> VAPOR EXTRACTION— <br /> 244 253 Clay SPARGING_ <br /> 253 257 Sand SOUTH REMEDIATION— <br /> 111ustrate or Ascrtbe Distance of Well from Roads, Buildings, <br /> 257 262 Clay 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 1 <br /> DEPTH OF STAT C <br /> WATER LEVEL 0 (Ft.)&DATE MEASURED 6/22/2017 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 262 (Feet) TEST LENGTH <br /> (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 262 (Feet) May not be representative o a well's lon -term yield <br /> DEPTH CASING(S) ANNULAR MATERIAL <br /> FROM SURFACE BORE- TYPE ! DEPTH <br /> HOLE — FROM SURFACE TYPE <br /> DLA. Y w o MATERIAL/ INTERNAL GAUGE SLOT SIZE <br /> CE- BEN- <br /> (Inches) z w p a GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> Ft. to Ft. m v (Inches) THICKNESS (Inches) Ft. to Ft. (TYPE/SIZE) <br /> to u ✓ (✓) L) <br /> 0 242 12 <br /> 242 262 045 100 262 '/ GRAVEL <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,FAK,OR CORWCONSEUTIVELY <br /> TED) <br /> — Soil/Water Chemical Analysis 119 Alb R 7 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT OASTS. Signed 07/10/17 668622 <br /> WELL DRILLER/AUTHOR DATE SIGNED C57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NMBERED FORM <br />