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ORIGINAL STA TF OF CM IFORNIA OWR USE ONLY — 00 NOT FILL RJ <br /> File with DWR tL WELL COMPLETION REPORT ;'-A,' '.(I L'_ <br /> Page I of I ` �r r/O Rrler In 1-1—'1- Pamyblel STATE WELL NO.I STATION NO. <br /> Owner's Well No. 95366 No.e0323079 1,z <br /> Date Work Regan 8/30/2016 Fnded9/16/2016 uTITUOE LONGITUDE <br /> Local Permit Agency Ermlirnnmentat Health <br /> Permit No. 75516 Permit I1ate 6/18/2016 APNfrRSR)THER <br /> GEOLOGIC LOC <br /> ORIENTATION(v) ✓ VERTICAL HORIZONTAL ANGLE (SPECIFY) <br /> DRILLING <br /> DEPTH FROM METHOD ROTARY FLUID Mud <br /> SURFACE DESCRIPTION <br /> Ft to Ft _ Describe material, gram. size, color. etc. <br /> 0 2 Top Soil <br /> Addnss 19143 S Carrolton`lYd <br /> 2 8 Sand City Ripon CA 95366 <br /> 8 40 Clay County San Joaquin <br /> 40 55 Sand APN[look Pagc Parcel <br /> 55 63 Clay Township Range Section <br /> 63 79 Sand Latitude <br /> 79 123 Clay DEG MIN SEC DEG MIN SEC <br /> 123 133 Sand LOCATION SKETCH ACTIVITY (�) <br /> NORTH ✓ NEW wFlt. <br /> 133 149 Clay MODIFICATIONIRLPAIR <br /> 149 151 Sand Deepen <br /> 151 156 Clay Omm(Speray) <br /> 156 160 Sand <br /> DESTROY(Desafbe <br /> 160 176 Clay Under*GEOLOGIC LOG' <br /> 178 179 Sand PLANNED USES(") <br /> 179 183 Clay r W✓EDomesecLY Pubhc <br /> 183 191 Sand ','"ion IndustnW <br /> 191 203 Clay MONITORING <br /> 203 208 Sand TEST WELL <br /> 208 209 Clay ATHODIC PROTECTION. <br /> 209 213 Sand HEAT EXCHANGE <br /> DIRECT PUSH <br /> 213 275 Clay <br /> INJECTION <br /> 275 279 Sand <br /> VAPOR EXTRACTION <br /> 279 292 Clay SPARGING <br /> 292 295 Sand SOUTH REMEDIATION <br /> fllunvrr ur jX nbefAs a.,u 4WellJ Raadr,flm/dnS, <br /> Fenw.Riven,ne end—ch•map U. dda—1 paper f OTHER(SPECIFY) <br /> nfary.PLEASE BE ACCURA'FF: & COMPLETE <br /> WA'rER LEVEL&YIELD OF C OMPLE:FF.D WELL <br /> DEPTH TO FIRST WATER (FI.)BELOW SURFACE 1 <br /> DEPTH OF STAT C 8/30/2016 <br /> WATER LEVEL 6 (Ft)&DATE MEASURED <br /> FSTIMATED YIELD (GPM)&TEST TYPE <br /> TUTAI DI'PIHOF BORINCI 295 (Feet) TEST LENGTH (Hn.) TOTAL DRAWDOWN (Ft.) <br /> TUTAI D1111'H01:C'UMPI1-ILD WI'I.1 285 (Feel) May not be representative oawell'slon -term yield, <br /> DEPTH CASING(S) _ DEPTH ANNULAR MATERIAL. <br /> FROM SURFACE BORE- TYPE ) -- - FROM SURFACE I. TYPE _ <br /> HOLE (' <br /> DIA. Y w ¢ MAIERIAI I INTERNAL GAUGE SLOT SIZE CE- BEN <br /> jinches Z iO u FILTER PACK <br /> w u~ 2 GRADE DIAMETER OR WALL IF ANY MENT TONITC FILL (TYPFJSIZ.E) <br /> Ft to Ft I m N LL (inches) THICKNESS (Inches) FL to FL <br /> 0 265 12 ✓ PLASTIC 6 200 0 1001 <br /> 265 285' ✓ .045 100 285, ✓ GRAVEL <br /> i <br /> i <br /> 417'T.AC HME'STS (. ) C E.RTIFICA'PION STATEMENT <br /> GedoW Log I.Bre hmdersgw.oe"mat ties raped is oornplete and accwete to the best of my knOW edge end beW. <br /> wee Const—bon Dmgrarn NAME MASELLIS DRILLING INC Owl <br /> GeophysMal Lis) (PERSON,FIRM, R TION IfSCIVWatw Chellacal Analysis 11S Albeni RdModesto CA 95357 <br /> ADDRESS CITY STATE LP <br /> oma 09/16/16 6611622 <br /> ATTACH ADDITIONAL INFORMATION,IF ITEXISTS. <br /> ��WELL DRILLER/AUTHORD7=D R SENTATNE DATE SIGNED C57 LICENSE NUMBER <br /> DWR Ir&RI V 1I-47 IF ADDITIONAL SPACE IS NEEDED.USE NEXT CONSECUTIVELY NUMBERED FORM <br />