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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT FI_i I I I � I I I I I <br /> Page 1 of 1 Rifer to iustnnction Pannpblet STATE WELL NO.I STATION NO. <br /> Owner's Well No. 95366 No.0937023l I I I 1 1 <br /> Date Work Began 8/8/2006 Ended8/22/2006 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health _ _ I I I I I I I I I I I I I <br /> Permit No. 47692 Permit Date 8/4/2006 APNITRSIOTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) �- VERTICAL _HORIZONTAL —ANGLE —(SPECIFY) Name Fredriks Nursery <br /> DEPTH FROM MDRILLINGETHOD R- TARP FLUID Mud Mailing Address 23223 S.Austin Rd. <br /> SURFACIE DESCRIPTION B!Pon _ _ __ CA 95366 <br /> FC to Ft. Describe material, grata, size, color, etc. CITY STATE ZIP <br /> 0: 3:SoilLL LOCATION <br /> 3? 7 Sand Address 23245 S.Austin Pd._ _ <br /> — City Ripon CA <br /> 7 28 Clay CountySan Joaquin <br /> 28:. 33.:Sand APN Book- Page Parcel_ <br /> 33: 73:Clay <br /> ---------- ---- Township.—__.._--Range. Section -- <br /> 73: 771 Sand Latitude <br /> 77: 105:Clay DEG. MIN. SEC. DEG, MIN. SEC <br /> 105: 110:Sand — LOCATIIONSKETCH ACTIVITY NORTM (�) <br /> 110: 117:Clay _ +� NEW WELL <br /> 117 121 Sand MODIFICATION/REPAIR <br /> Deepen <br /> 121; 160 Clay _ Other(Spey) <br /> 160: 165:Sand <br /> - -- ----.—. _ -__. -- DESTROY(Describe 1�f <br /> 165: 177 Clay Procedures and Materials c�,/' <br /> 177: 190 Sand Under"GEOLOGIC LOG N <br /> PLANNED IISES(Z) <br /> 190: 230:Clay __ _ WATER SUPPLY <br /> 230: 235;Blue Clay <br /> Domestic— Public <br /> — Irrigation _ Industrial <br /> MONITORING-- <br /> TEST WELL <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH__ <br /> INJECTION <br /> VAPOR EXTRACTION— <br /> SPARGING <br /> - -- <br /> - SOUTH REMEDIATION <br /> 11h arrate or Lksmbe Distance of Well irony HrxiA Ituddingc. <br /> Fences,Rivers,etc. and attach a map. Useadditional paper if OTHER(SPECIFY)— <br /> necessary. PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVEL&VIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft)BELOW SURFACE 1 <br /> DEPTH OF STATIC 8/9006 <br /> WATER LEVEL-..._4_ - <br /> (Ft)8 DATE MEASURED__ <br /> -'------ ESTIMATED YIELD '__ (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 235 (Feet) TEST LENGTH---(Hrs.) TOTAL DRAWDOWN- (FL) <br /> TOTAL DEPTH OF COMPLETED WELL203 (Feet) May not be representative o a i ell's long-term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE- 07! <br /> FROM SURFACE TYPE <br /> HOLE I <br /> DIA. MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft to Ft (Irtehsa) GRADE (Inches) THICKNESS (lis) Ft. to Ft AMETER OR WALL IF ANY ME NT TON FILL FILTER <br /> I(T PEISIZE) <br /> (�) "VI <br /> 0: 163 14 ✓ I I pLASTIC 8 160 0 i 100 <br /> 163: 203 — _ 100 ; _ .AVE L <br /> _j <br /> KITACHNIENTS 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 /> Weli Construction Diagram NAME MASELLIS DRILLING.INC. _ - _-_. <br /> Geophysical Log(s) (PERSON.FIRM,OR COLRD <br /> ION)(TYPED OR PRINTED) <br /> SoiVWater Chemical Analysis 119 Albers Rd Modesto ___ CA 95357 <br /> Other ADDRESS r J/�J/J� / /f CITY STATE ZIP <br /> 68 <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 08/22106 6622 <br /> WELL DRILLERIA REPRESENTATIVE DATE SIGNED C-67 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />