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QUADRUPLICATE STATE. OF CALIFORNIA —DWR IUSE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 1 of 1 Refer to Irrstruction Pamphlel STATE WELL N0./STATION NO. <br /> Owner's Well No. 95236 NO.e0366508 I I 1 1][11 1 1 1 1 1 ❑ <br /> Date Work Began 5/17/2018 Ended5/21/2018 LATITUDE LONGITUDE <br /> Local Permit Agency EnvironmentaLHealtlL I I I I I I I I I I I I I I <br /> Permit No. wp0038204 Permit Date 5/1/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -v VERTICAL —HORIZONTAL — ANGLE —(SPECIFY) Name Drew Chaney <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address P.O. BOX 555 <br /> F DESCRIPTION Linden CA 95236 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 4 Top Soil Address 2430 N. Murray FILL LOCATION <br /> 4 48 Clay Cit,Linden CA 95236 <br /> 48 581 Gravel and Rocks County San Joaquin <br /> 581 64 1 Rocks APN Book Page Parcel <br /> 641 127 Clay Township Range Section <br /> 127 131 Gravel Latitude t <br /> 131 180 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 180 182 Sand LOCATION SKETCH ACTIVITY (�) <br /> NORTH —I'— NEW WELL <br /> 182 187 Clay <br /> 187 204 Sand MODIFICATION/REPAIR <br /> 240 220 Clay Deepen <br /> —Other(Specify) <br /> 220 221 Sand <br /> 221 229 Clay — DESTROY(Describe <br /> Procedures and Materials <br /> 229 246 Sand Under"GEOLOGIC LOG" <br /> 246 266 Clay PLANNED USES() <br /> WATER SUPPLY <br /> 266 268 Sand �C Domestic— Public <br /> 268 298 Clay — Irrigation _ Industrial <br /> 298 300 Sand MONITORING— <br /> 300 3031 Clay TEST WELL— <br /> ATHODIC PROTECTION- <br /> 303 304 Sand HEAT EXCHANGE- <br /> 304 355 Clay DIRECT PUSH— <br /> INJECTION <br /> VAPOR EXTRACTION— <br /> SPARGING_ <br /> SOUTH REMEDIATION <br /> /Ilostratr ar Describe Distance of(Yell frons Roads, Buildings, <br /> Fences,Rivers,etcand attach a map. Use additional paper it' OTHER(SPECIFY)— <br /> necessary. PLEASE BE ACCUR.tTE & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STATIC <br /> WATER LEVEL 144 (Ft.)&DATE MEASURED 5/21/2018 <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> rOTAL DEPTH OF BORING 355 (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL275 (Feet) <br /> kfav not be representative of a well's long-term vield. <br /> DEPTH BORE- ____-___CASING(S) ___ DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE !) FROM SURFACE TYPE <br /> DIA. T <br /> a MATERIAL/ INTERNAL GAUGE SLOT SIZE <br /> (Inches) Q a- GRADE DIAMETER OR WALL IF ANY CE- BEN- FILTER PACK <br /> Ft. to FI. LL (Inches) THICKNESS (Inches) Ft. to Ft. MENT TONIT FILL F m p�SIZE) <br /> (�) L) <br /> 0 235 105/8 PI ASTIC 200 0 104 <br /> 235 275 1 .045 104 5GRAVEL <br /> ATTACHMENTS (r ) 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,FIR OR CORPORA ION) (TYPED,OR PRINTED) <br /> — Soivwater Chemical Analysis 119 Al ers Rd t Ni 8 °,g a 3 M <br /> A 95357 <br /> Other ADDRESS `sf, 7 r ,§1 -: CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,(FITEXISTS. Signed t ;" r °'1�0y"F' 06/05/18 668622 <br /> WELL DRILLI=R/AUTHORt N PRESENTATIVE( DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT"CONSECUTIVELY NUMBERED FORM <br />