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ORIGINAL STATE OF C•SI IFORNIA DWR USF ONLY — On NOT FILL IN <br /> File with DWR t!7C ilr ib WELL COMPLETION REPORT _ "'A 1' '.L <br /> Page 1 of 1 / Refer In Iiivi—non Pamphlrt STATE WELL NO.1 STATION NO. <br /> Owner's Well No. 95366 No-e0323079 <br /> Date Work Began 8/30/2016 F:nded9/16/2016 LATITUDE' LONGITUDE <br /> Local Permit Agency Enyirnnmental Hea1{h I <br /> P <br /> Permit No. Permit Date <br /> 75516 8/18/2016 APNIRS/OTHER <br /> GEOLOGIC LOC <br /> ORIENTATION ✓ VERTICAL HORIZONTAL ANGLE (SPECIFY) <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud <br /> SURFACE OES('RLPTION <br /> Ft to Ft Describe material, grain, size, color. etc. <br /> 0 2 Top SoilAddress 19143 S Carrolton`l�`cf <br /> 2 8 Sand City Ripon CA 95366 <br /> 8 40 Clay C•ountySan Joaquin <br /> 40 55 Sand APN Book Page Parcel <br /> 55 63 Clay Township Range Section <br /> 63 79 Sand Latitude <br /> 79 123 Clay DEG MIN. SEC DEG MIN SEC. <br /> t23 133 Sand LO('ATION SKETCH ACTIVITY (.1) <br /> NORTH V NEW WELL <br /> 133 149 Clay <br /> MODIFICATION/REPAIR <br /> 149 151 Sand Deepen <br /> 151 156 Clay Other(Spews <br /> 156 160 Sand <br /> DESTROY(Destro <br /> 160 178 Clay Pioced—and Ms, <br /> Under"GEOLOGIC <br /> 178 179 Sand <br /> PLANNED USES( <br /> 179 183 Clay WATERUPP <br /> ✓DonxsticLv PUD <br /> 183 191 Sand in <br /> 191 203 Clay MONITORING <br /> 203 208 Sand TEST WELL <br /> 208 209 Clay ATIIODIC PROTECTION <br /> 209 213 Sand HEAT EXCHANGE <br /> 213 275 Clay DIRECT PUSH <br /> NJECTION <br /> 275 279 Sand <br /> VAPOR EXTRACTION <br /> 279 292 Clay SPARGING <br /> 292 295 Sand SOUTH REMEDIATION <br /> reumvlr w lle.u.'nhe <br /> J.—./Well)R-dt A lhh.ill. <br /> Frnces.Rivers.ec ehd-ch a map Cae additwmt paper If OTHER(SPFCIFY) <br /> acesary.PLEASE BE ACCURATE & COMPLF.TF- <br /> WATER LEVEL&VIELD OF(OMPLETED WELL <br /> DEPTH TO FIRST WATER (FL)BELOW SURFACE 1 <br /> DEPTH OF STAT C 8/30/2016 <br /> WATER LEVEL 8 (FI.)&DATE MEASURED <br /> ESTIMATED YIELD' (GPM)&TEST TYPE <br /> TOTAI DI F11 I OF BURIN(, 295 (F'cet) TEST LENGTH (His) TOTAL DRAWDOWN (Fit <br /> TUI AI DLPTH OF COM PI I TED W EI 1 285 (F•ccO I May not be re recentaim o a well's long-term yield. <br /> DEPTH (ASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE TYPE{�1 FROM SURFACE TYPE <br /> DIA. Y wj¢T MATERIAL 1 INTERNAL GAUGE SLOT SIZE CE BEN- <br /> (Inches) Z N GRADE DIAMETER OR WALt IF ANY MENT TONIT FILL FILTER PAC <br /> FI to FI I m w OLA LL (Inches) THICKNESS (Inches) FI to Fi. I (,)f(,) (TYPF/SIZEI <br /> 0 265 12 ✓ PLASTIC 6 200 0 1001 ✓ <br /> 265 285! ✓ .045 100 2$51 ✓ GRAVEL <br /> i <br /> i <br /> (TLA(HMENTS (r I (ERTMCATION STATEMENT <br /> Csecophc Lop 1 the unoermpned,Tartly VW this MPon IS OCRIPWO 3M Malate to UM Dell or my IVvitiledge and Weer. <br /> Well CoUsINchOn Dhapram NAME MASELLIS DRILLING INC <br /> Gaophyshvl Lops) (PERSON,FIRM,RKISENTATYVE <br /> EJ• I <br /> SoIVWMw CWmIrBI Analysis 119 AlherS Rd Modesto CA 95357 <br /> AUUHESS 'Tr CITY STATE Zip <br /> 09— 09/16/16 66.8M <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS WELL DRILLERUUTHODATE SIGNED CS7 LICENSE NU <br /> DWT(lee lU Y 11-47 IF ADDITIONAL SPACE IS NEEDED.USE NEXT CONSECUTIVELY NUMBERED FORM <br />