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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT ) 1. 1 I 1 1 _D <br /> Page 1 of 2 Rejer to Instruction Panipklel _ _ STATE WELL NO./STATION NO. <br /> Owner's Well No. 95236 _ _ — 1 I I <br /> "°'e0269812 _ <br /> Date Work Began 4/17/2015 Ended6/10/2015 _._ I LATITUDE _ LONGITUDE _ <br /> Local Permit Agency FrIldrd�t?.tani Health L1 1 I I I 1 1 1 1 1 I <br /> 71599 _ 2/26/2015 APNITRs/OTHER <br /> Permit No. Permit Date —_—_ <br /> GEOLOGIC LOG WELI.OWNER <br /> ORIENTATION(,e) VERTICAL - -HORIZONTAL — ANGLE _—(SPECIFY) Name Robert Dondero <br /> DRILLING ROYAL — FLUID Mud Mailing Address2210 MUrry RR <br /> DEPTH FROM METHOD CA 95236 <br /> �U DESCRIPTION Linden _ _ _ _ <br /> _Ft to Ft. Describe material, grant, sLe, color, etc. Cm STATE ZIP <br /> 2 <br /> 0. 3 Top Soil _ _ _— Address 210 Mum Rd ALL LOCATION <br /> 3 47 Clay _ _ _ City Linden CA 95236 <br /> 47 52 Shale County San Joaquin <br /> 52 56 Sand _ APN Book Page _ Parcel <br /> 56 _70'Shale _ Township— -- Range_ Section _ <br /> 70. 76 Clay _ _ _ _ Latitude __ — <br /> 76: 113 Shale DEG. MIN. SEC. DEG. MIN. SEC. <br /> 1— i - - Sand - - LOCATION SKETCH ACTIVITY (✓) <br /> _ -- — NORTH - _3C NEW WELL <br /> 116, 120.Shale <br /> MODIFICATION/REPAIR <br /> 120' 125 Sand_ —Deepen <br /> 125 i 135'Shale - — Ower(Spec'ty) <br /> 1357 138;Sand <br /> _ DESTROY(Describe <br /> 138 150:Shale Procedures and Materials <br /> — Under"GEOLOGIC LOG" <br /> 150; 185 Clay _ _ PLANNED USES(.z) <br /> 185 187 Sand __ WATER SUPPLY <br /> 187 192:Shale _ _ N <br /> F' Domestic__ PubAc <br /> uj <br /> 192 195'Sand - irrigation __ Industrial <br /> 195 238'$hale — MONITORING <br /> _ TEST WELL <br /> 238, 245 Sand _ ATHODIC PROTECTION <br /> 245' 276 Shale HEAT EXCHANGE <br /> 276 285 Black Sand DIRECT PUSH <br /> 285 297:Shale INJECTION <br /> -- - VAPOR EXTRACTION <br /> 297 302:Black Sand _ - _ SPARGING_ <br /> 302 306•Shale — SOUTH REMEDwnON <br /> 111uvratc or Describe Dtstanee of bull frau Rwdv, Bmrdiugs, <br /> 306' 310 Black Sand Fences.Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY) <br /> _ 310; 322 Shale - neeemry. PLFASE BE ACCURATE & COMPLETE. <br /> 322 325 Black Sand WATER LEVEL&YIELD OF COMPLETED WELL <br /> 3255 350 Shale DEPTH TO FIRST WATER- (Ft)BELOW SURFACE <br /> 350 353 Black Sand DEPTH OF STATIC <br /> 353' 388 Sh21e — WATER LEVU 150 (Ft)&DATE MEASURED 6/10/2015 <br /> - - --- ESTIMATED YIELD — (GPM)&TEST TYPE __ <br /> TOTAL DEPTH OF BORING 560 (Feet) TEST LENGTH__ (Hrs.) TOTAL DRAWDOWN _ (Ft) <br /> TOTAL DIM OF COMPLETED WELL 540 (Feet) Afty not be re resentattve o a ivell's lot -term yield <br /> DEPTH BORE- CASING(S) DEPTH I ANWRAR ALATERIA1.FROM SURFACE HOLE TYPE ! FROM SURFACE TYPE <br /> —' - - DIA. Y l a MATERIAL/ INTERNAL' GAUGE SLOT SIZE - - CE- BEN- 1 <br /> Ft to Ft (inches) S O GRADE DIAMETER OR WALL IF ANY MENT'TONITE FILL FILTER PACK <br /> m V LLA (Inches) I THICKNESS I (inches) Ft to Ft (TYPE/SIZ <br /> (20 �) — E - <br /> 0 300_ 24. ✓I STEEL 16 _ 1/4. Q 5Q / t <br /> _300' 540 1 ✓' t M 50 540 '� 1 aRAVEL <br /> ATTACIINIENTS CERTIFICATION STATEb1ENT <br /> Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowiedge and better <br /> Well Construction Diagram NA,WE MAS LIS DRILLING INC <br /> Geophysical Log(s) (PERSMV <br /> "SiEiNTAT <br /> INTED) <br /> SOGWater Chemical Analysis Other _ _ ADDRESS CITY STATE ZIP <br /> ATTACHADDITIONALiNFORMATrON,1FITEXISTS S9� 06/10/15 <br /> WELL DRILLER DATE SIGNED CS/LICENSE NUMBER <br /> DNR 19&REV 11-o7 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />