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Well Owner Geologic Log <br />260 275 Planned Uses <br />C) Water Supply <br />(:)Domestic El Public <br />0 Irrigation 0 Industrial <br />0 Cathodic Protection <br />0 Dewatering <br />0 Heat Exchange <br />0 Injection <br />0 Monitoring <br />O Remediation <br />0 Sparging <br />0 Test Well <br />0 Vapor Extraction <br />0 Other <br />brown sandstone <br />lituat/010 Of de801100 (001a0Ce Olweil lion,Made. buildings, 100E00. <br />14003, 0/0 and tollbch a mop Use 40,010ional paps, IIne00essary <br />Please be sccurate and complain <br />South <br />Material Type <br />Casings <br />Depth from Borehole <br />Surface Diameter <br />Feet o Feet (Inches) <br />Wall Outside Screen Slot Size <br /> <br />Thickness Diameter Type If Any <br /> <br />(Inches) (Inches) (Inches) <br />Annular Material <br />Depth from <br />Surface Fill Description <br />Feet o Feet <br />100 195 12 6 Cement Blank <br />Screen 100 275 12 6 Fill pea gravel 195 275 <br />PVC cls200 <br />PVC cls200 Milled Slots <br />fl <br />4/V1.001:1"- <br />C-57 Licensed Water Well Contractor <br />Signed <br />City Slots Zip <br />08/13/2014 299383 <br />Date Signed C-57 License Number <br />'The free Adobe Reader may be used to view and complete this form However, software must be purchased to complete, save, and reuse a saved form <br />Depth from Surface <br />Feet to Feet <br />0 17 hard clay <br />0Angle Specify <br />Drilling Flute Polymer mud <br />Description <br />Describe material, grain size, color, etc <br />Well Location <br />Orientation ®Vertical 0 Horizontal <br />Drilling Method Direct Rotary <br />Water Level and Yield of Completed Well <br />Total Depth of Boring 275 <br />Total Depth of Completed Well 275 <br />Depth to first water 140 <br />Depth to Static <br />Water Level <br />Estimated Yield * <br />Test Length <br />(Feet below surface) <br />(Feet) Date Measured <br />(GPM) Test Type <br />(Hours) Total Drawdown (Feet) <br />"May not be representative of a well's long term yield. <br />Attachments <br />0 Geologic Log <br />0 Well Construction Diagram <br />0 Geophysical Log(s) <br />0 SoilANater Chemical Analyses o Other <br />Attacn additional Information, It it exists. <br />DWR 168 REV 1/2006 <br />Certification Statement <br />i, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief <br />Name Valley Drilling <br />Person. Firm or Corporation <br />P.O. 13 ox 42 <br />IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />011 A 95632 <br />Address same <br />47 35 City <br />Latitude <br />Deo <br />Datum <br />APN Book <br />Township <br />60 47 <br />60 77 <br />83 77 <br />83 117 <br />Section 117 126 <br />126 140 <br />140 <br />Location Sketch <br />(Sketch must be drawn by hand after toml riled I 150 North <br />150 220 sandstone <br />sand <br />230 brown clay <br />236 gray sandstone <br />17 35 <br />220 230 <br />236 <br />260 <br />sand <br />sandy clay <br />clay <br />sandstone <br />sand <br />clay <br />sandy clay <br />sandstone <br />clay <br />County <br /> N Longitude <br />Mln Sec De d Mal Sec <br /> <br />Dec. Lat. Dec. Long. <br /> <br />Page Parcel <br />Range <br />Activity <br />0 New Well <br />0 Modification/Repair <br />0 Deepen <br />0 Other <br />0 Destroy <br />Dasarlaa proceouros and m0Ienafs <br />under 'GEOLOGIC LOG' <br />Feet <br />Feet <br />State of California <br />Well Completion Report <br />Refer to Instruction Parrohret <br />No. e0228711 <br />Date Work Ended 8/6/2014 <br />Permit Date 8/4114 <br />File Original with DWR <br />Page of <br />Owner's Well Number <br />Date Work Began 08/05/2014 <br />Local Permit Agency San Joaouin <br />Permit Number SR0070217 <br />DWR Use Only — Do Not Fill In <br />iO4NO7E11 <br />j38 12 26N 121 10 19W <br />i007-400-59 1 <br />APNITRStOther