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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY - DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 2 of 2 Refer to Instruction Pamphlet STATE WELL NO.I STATION NO. <br /> Owner's Well No. 95236 No-e0269812 I ❑ <br /> Date Work Began 4/17/2015 EDded6/10/2015 __ LATITUDE LONGITUDE —� <br /> Local Permit Agency Environmental Health 11 I _J_ 11 I. 1 "(_ 1 1_1 <br /> P <br /> Permit No. ermit Dale <br /> 71599 2/26/2015 APNMS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) - VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Robert Dondero <br /> DRILLING ROTARY Mud Mailing <br /> Address 2210 Murry Rd <br /> DEPTH FROM METHOD — FLUID _ _ - S <br /> SURFACF� DESCRIPTION Linden CA 95236 <br /> FL to FL Describe_ material, o a_ins_ize, color, etc. CITY STATE ZIP <br /> 388 394 Black Sand — 2210 Mur Rd WELL LOCATION- <br /> Address ry -- <br /> 394 415 Shale _ City Linden CA 95236 <br /> 415 416:Black Sand County San Joaquin <br /> 416. 443 Shale _ _ — APN Book Page Parcel <br /> 443; 453 Black Sand Townshi <br /> 4531 472 Shale p-- — Range Section . <br /> Latitude__ <br /> 472; 477 i Black Sand DEG. MIN SEC. DEG MIN. SEC <br /> 477: 485 Shale — LOCATION SKETCH ACTIVITY (.1) <br /> ----- -- --- NORTH -. ✓ NEW WELL <br /> 485 490 Black Sand <br /> 490' 517 Shale MODIFICATION/REPAIR <br /> _ Deepen <br /> 517, 520:Black Sand — Other(Speedy) <br /> _520; 525.Shale <br /> DESTROY(Descnte <br /> 525: 528:Black Sand Procedures and Matenals <br /> 528 560'Shale Under"GEOLOGIC LOG" <br /> - -— PLANNED USES(+1) <br /> WATER SUPPLY <br /> E0 r j Domestic— Public <br /> - - - -- - ¢ Irrigation _ Industrial <br /> 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 Yell from Road% Buildings, <br /> Fences,Rivers,etc. and attach a rap, Use additional paper if OTHER(SPECIFY) <br /> -- - - - necessary. PLEASE BE ACCURATE & CONIPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER- (FL)BELOW SURFACE <br /> DEPTH OF STATIC <br /> --- - '- - WATER LEVEL_150— (FL)&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 DEPTI l OF COMPLETED WELL 540—(Feet) Alcry not be representative o a well's ton -term Melte <br /> DEPTH CASING(S) DEPTH ANNULAR AfArERIAL <br /> HOLE TYPEV2. <br /> I FROM SURFACE TYPE _ <br /> FROM SURFJ300- <br /> BORE - <br /> (inches)A. I tWu I MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- I BEN-I <br /> FL to Fg W,Oci GRADE DIAMETER OR WALL IF ANY MENT TONITE FILL FILTER PACK <br /> U aI (Inches) THICKNESS (inches) Fl to Ft (TYPEISIZE) <br /> 0, 24 ✓N LL I STEEL 16. _ 1./4 0 50300 ✓� I __ 60 50 54 `—j G.RA—EL_. <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 Constnrction Diagram NAME MASELLIS DRILLING INC <br /> Geophysical Log(s) (PERSO' W OR CDR P0 TION TYf INTED) <br /> SoffWater Chemical Analysts <br /> Other- ADDRESS CITY STATE ZIP <br /> ATTACH ADD177ONAL INFORMATION,IF ITOOSTS. Sign- _ 06/10/15 - <br /> /A <br /> WELL DRILLERUTH ZED REP ENTAT E DATE SIGNED G57 LICENSE NWASER <br /> DWR I8s REV 11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />