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ANNULAR MATERIAL <br />TYPE <br />DEPTH <br />FROM SURFACE <br />MATERIAL / <br />GRADE <br />INTERNAL <br />DIAMETER <br />(Indies) <br />305 325! .045 <br />WELL DRILLER/AUTHORIZE iRE5EpTATIVE <br />IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />12/20/16 <br />DA t E SIGNED <br />TYPE (v <br />7 M <br />Z <br />51 <br />LLE Z <br />,t EN <br />0 305 105/8 1 <br />CASING (S) DEPTH I BORE- <br />FROM SURFACE HOLE <br />DIA <br />(Indies) <br />1-1 10 Ft I <br />PLASTIC 6 200 <br />GAUGE <br />OR WALL <br />THICKNESS <br />SLOT SIZE <br />IF ANY <br />(Inches) <br />CE- BEN- <br />, MENT TONITE FILL <br /> <br />) ) <br /> <br />0 100 1 <br /> <br />100 3251 <br />FILTER PACK <br />(TYPE/SIZE) Ft to Ft <br />1 GRAVEL <br />CERTIFICATION STATEMENT <br />the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief <br />NAME MASELLIS DRILLING INC <br />(PERSON, FIR CORPORATI (TYPED oR PRINTED) <br />119 Albers Rd Modesto <br />ADDRESS CITY <br />Geologic Log <br />Well Construchon Diagram <br />Geophysical Log(s) <br />Soil/Water Chemical Analysis <br />Other <br />ATTACH ADDITIONAL INFORMATION, IF IT EXISTS Signed <br />ATTACHMENTS ( I I <br />DWR \ <br />CA 95357 <br />STATE ZIP <br />668622 <br />C-57 LICENSE NUMBER <br />ORIGINAL <br />File with DWR <br />Page I of I <br />Owner's Well No. 95215 <br />f ATF OF CALIFORNIA <br />WELL COMPLETION REPORT <br />NAT to Irntrz.c (Ion Pumphlet <br />NcLe0331303 <br />Date Work Regan 12/12/2016 Fnded12/13/2016 <br />I ,ocal Permit Agency Fro/iron/Dental Health <br />Permit No. 76223 Permit Date 11/15/2016 <br /> GEOLOGIC LOG <br />ORIENTATION (1) VERTICAL HORIZONTAL ANGLE (SPECIFY) <br />DRILLING <br />, METHOD ROTARY <br />DwR USE ONLY — DO NOT EILL IN-- <br />1 <br />STATE WELL NO./ STATION NO <br />- „ <br />LATITUDE LONGITUDE <br />APNITRS/OTHER <br />DEPTH FROM <br />suRTACE DESCRIPTION <br />Ft to Ft Describe material grain. size color. etc <br />FLUID Mud <br /> <br />0 1 Top Soil <br /> <br />1 6 Hard Pan <br /> <br />6 23 Clay <br /> <br />23 28 Sand <br /> <br />28 41 Clay <br /> <br />41 47 Sand <br /> <br />47 173 Clay <br /> <br />173 176 Sand <br /> <br />176 188 Clay <br /> <br />188 192 Sand <br /> <br />192 230 Clay <br /> <br />230 231 Sand <br /> <br />231 277 Clay <br /> <br />277 279 Sand, <br /> <br />279 306 Clay <br /> <br />306 307 Sand <br /> <br />307 312 Clay <br /> <br />312 320 Sand <br /> <br />320 340 Clay <br />Address 11807 Bendorf Frd— <br />city Acampo CA <br />County San Joaquin <br />APN Book Page <br />Township Range <br />latitude <br />DEG MIN SEC <br />LOCATION SKETCH <br />NORTH <br />SOUTH <br />illustrate or Pc 14. r7ht Pawns, of Well from Roods. /holdings. <br />Fences, Rivers. etc and attach a map Use additional paper if <br />necessary. PLEASE RE ACCURATE & corvimrrk. <br />DEG MIN SEC <br />ACTIVITY ) <br />1 NEW WELL <br />MODIFICATION/REPAIR <br />Deepen <br />Other (Specify) <br />DESTROY (Describe <br />Procedures and Materials <br />Under "GEOLOGIC LOG" <br />PLANNED USES ( 1 ) <br />WATER SUPPLY <br /> <br />vf.' Domestic Public <br /> <br />Imgation Industrial <br />MONITORING <br />TEST WELL <br />ATHOUIC PROTEC DON <br />HEAT EXCHANGE <br />(DREG( PUSH <br />INJECTION <br />VAPOR EXTRACTION <br />SPA RGING <br />RE MEDIATION <br />OTHER (SPECIFY) <br />Parcel <br />Section <br />WATER LEVEL & IELD OF ( OMPLETED WELL <br />DEPTH TO FIRST WATER (FL) BELOW SURFACE <br /> 1 <br />DEPTH OF STATIC <br />WATER LEVEL 148 <br />ESTIMATED YIELD • <br />(Ft )8. DATE MEASURED <br />(GPM) 8, TEST TYPE <br />12/19/2016 <br />TEST LENGTH (Hrs TOTAL DRAWOOWN <br /> (Ft ) <br />May not be representative of a well's long-term yield. <br />Ft )TAl DI T1 II It H. BORING 340 (feet) <br />11 rim i)Frti (..'omPt.t'II D I 325 <br />(Feet)