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DUPLICATE• STATE; OY CALIFORNIA W R USE ONLY - 00NOT FILL I N <br /> Driller's Copy WELL COMPLETION REPORT <br /> 1 1 Refer to Instruction Pamphlet STATE WELL NO.i STATION NO. <br /> Page of 1 <br /> Owner's Well No. No. 437540 <br /> Date Work Began Ended 07/24/96 LATITUDE ❑ LONGITUDE <br /> Local Perrnil A r } <br /> Permit No. 4 Pcrinit Date APNtTRSiQT <br /> HER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION (v) X VERTICAL _ HORIZONTAL _ ANGLE _(SPECIFY) Narne Bill Dejong <br /> DEPTII TO FIRST WATER (Ft 1 BELOW SURFACE; Mailing Address 22550 ice <br /> DEPTH FROM Manteca A 95337 <br /> SURFACE DESCRIPTION <br /> Ft. t0 Ft. Deserthe materral, asize,Color,etc. CITY STATE ZIP <br /> �m `�iEl�' �oc.AT1oN i <br /> Soil Address 20802 Ps ury <br /> 4 22 Sand City an eca <br /> 22 60 syCounty SanJoaquin <br /> a nd APN B(x)k Page Parcel <br /> 65 98 Clay Township Range Section <br /> 98 110 SAnd or <br /> 110 115 Latitude I I NORTH DEG. I � WEST Sand DEC MIN. SEC. DEG. MIN SEC <br /> LOCA'T'ION SKETCH CTIVITY (!) <br /> 115 122 an Y Shale NORTH NEW WELL <br /> 122 123 1San <br /> MODIFICATION,REPAIR <br /> 123 142 � C ay & shale _Deepen <br /> 142 148 : Sand <br /> _Other(Specify) <br /> 148 : 153 : Clay <br /> 153 155 Coarse San <br /> —DESTROY(Describe <br /> 155 a y Procedures and Materials <br /> Under"GEOL OGIC L OG") <br /> 158 159 San I- PLANNED LISE(S) <br /> 159 190 - Sandy Clay & Shale W w (�) <br /> 3 MONIT DRING <br /> 190 191 : San <br /> WATER SUPPLY <br /> 191 220 : Clay & Shale _ Domestic <br /> V Public <br /> ^ Irrigation <br /> Industrial <br /> 'TEST WELL" <br /> CATHODIC PROTEC <br /> SOUTH TION <br /> 111ustrate or Describe Dfstance of Well from Landnwrks _ OTHER(Specify) <br /> surh w Roads,Buildings,Fences,Ricxrs,etc. <br /> PLEASE BE ACCURATE & COMPLETE. <br /> DRILLING ROTARY WATER <br /> METHOD FLUID <br /> WATER LEVEL & YIELD OF COMPLETED WELL <br /> DEPTH OF STATIC 19 <br /> WATER LEVEL (Ft.) & DATE MEASURED <br /> L 220 ESTIMATED YIELD (GPM) & TEST TYPE <br /> TOTAL DEPTH 01' BORING lFe )2 TEST LENGTH (Hrs.) TOTAL DRAWDOWN (FL) <br /> TOTAL DEPTH OF COMPLETED NVELL 6 Feet) hlav not he represe-ruative of a-well's long-ternr yield. <br /> I <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL. <br /> FROM SURFACE BORE- TYPE 11 FROM SURFACE TYPE <br /> HOLE — INTERNAL GAUGE SLOT SIZE <br /> DIA. w a t MATERIAL/ CE- BEN- <br /> o DIAMETER OR WALL IF ANY FILTER PACK <br /> (Inches) a zoo GRADE MENT TONITE FILL <br /> Ft. to Ft. N (Inches) THICKNESS (Inches) Ft. to Ft. (TYPE/ <br /> SIZE) <br /> 0 102 20 PLASTIC 12 160 0 50 X <br /> 102 122 X 1 .045 50 161 X GRAVEL <br /> 122 142 <br /> 141 162 X <br /> ATTACHDIENTS (!�L) CERTIFICATION STATEMENT <br /> I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> Geologic Log <br /> Well Construction Diagram NAME MASELLIS DRILLING INC <br /> t PERSON. FIRM, OR CORPORATION) l"PID OR PRINTED) <br /> _ Geophysical Log(s)Geophy is Chemical4nalysea 119 Albers Rd Modesto CA 95357 <br /> ADDRESS CITY STATE ZIP <br /> Other <br /> ATTACH ADDITIONAL INFORMATION IF IT EXISTS. Signed /11 08/07/96 668622 <br /> 4;AUTHORI DATE SIGNED C-57 LICENSE NUMBER <br /> DWR IM BE% :-ao IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />