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QUADRUPLICATE STATE OF CALIFORNIA DWR USE_ONLY_ — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page I of I Refer to In.ctniclron Pamphlet STATE WELL NO.f STATION NO <br /> Owner's Well No. 9532 NO.e0369860 <br /> Date Work Began 9/26/2918 I'.nded9/27/2'018_ LATITUDE LONGITUDE <br /> El <br /> Local Permit Agency Environmental Health <br /> Permit No. WP0038789 Permit Date 9/20/2018 APN/TRSIOTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION VERTICAL HORIZONTAL - ANGLE --.(SPECIFY) Name Jennell Avila <br /> DRILLING ROTARY <br /> —0 PTH FROM METHOD FLUID Mud Mailing Address 28442 Lemon Ave <br /> sURFASE.- DESCRIPTION Escalon CA 95320 <br /> FL to Ft Uesc•ribe material, grain. size, color. etc. CITY STATE ZIP <br /> 0 3 Soil Address 28442 Lemon AveeLt.LOCATION <br /> Top <br /> 3 17 Shale City Escalon CA 95320 <br /> 17 27 Sand County San Joaquin <br /> 27 501 Clay APN Book Page Parcel <br /> 50 53 Sand Township Range Section <br /> 53 61 Clay Latitude I I I <br /> 61 70 Sand DEG. MIN SEC DEG. MIN SEC. <br /> 70 75 Clay LOCATION SKETCH ACTIVITY &) <br /> 75 95 Sand and Gravel NORTH –.V'— NEW WELL <br /> 95 117 Sand MODIFICATIONMEPAIR <br /> —Deepen <br /> 117 120 Clay —other(Speciry) <br /> 120 132 Sand <br /> — <br /> DESTROY (DescnW <br /> 132 133 Clay Procedures and Materials <br /> Under"GEOLOGIC LOG" <br /> 133 141 Sand PLANNED USES(Y-) <br /> 141 147 Clay WATER SUPPLY <br /> 147 152 Sand and Gravel u~i tL Domestic _ Public <br /> — lm.gabon -- Industrial <br /> 152 160 Clay <br /> 160 170 Sand MONITORING— <br /> TEST WELL <br /> 170 271 Clay THODIC PROTECTION- <br /> 271 273 Sand HEAT EXCHANGE- <br /> 273 285 Clay DIRECT PUSH- <br /> 285 287 Sand INJECTION— <br /> VAPOR EXTRACTION— <br /> 287 300 Clay SPARGING_ <br /> 300 345 Clay SOUTH REMEDIATION— <br /> 11tuilmtr ar desmhe Disramr t J 81,11 Jmm Powds. NuiWtngx, <br /> Ferm,Rivas,etc. and attach a map Ilse additional paper if OTHER (SPECIFY) <br /> neenaary. PLEASE BE ACCURATE & COMPLEM <br /> WATER LEVEL&VIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STATC <br /> WATER LEVEL 4 (Ft)8 DATE MEASURED 9/27/2018 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 345 (Feet) TEST LENGTH (Hrs) TOTAL DRAWDOWN (FL) <br /> TOTAL DEPTI I OF COMPLETED WELL 290 (Feet) AM3,not he representative o a well's long-term vield <br /> DEPTH CASING_(S) ANNULAR MATERIAL <br /> BORE- <br /> FROM SURFACE DEPTH <br /> HOLE TYPE _) FROM SURFACE TYPE <br /> DIA. Y. w a MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z p a GRADE DIAMETER OR WALL IF ANY HENT TONtT FILL FILTER PACK <br /> Ft to Ft m y o LL pncnes} THICKNESS Qnches) Ft to Ft (TYPE/SIZE) <br /> (_) UD <br /> 0 265 11 <br /> 265 290 .045 goo 290 GRAVEL <br /> ATTACIIMF.NTS CERTIFICATION STATEMENT <br /> — Geologic Log 1,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> — well Construction Diagram NAME MASELLIS_DRILLING INC <br /> — Geophysical Log(s) (PERSON,FHM,OR CORPO SON) (TYPED OR PRINTED) <br /> — SoiliWater Chemical Analysis 119 Albers R� 1'l f A r t to CA 95357 <br /> — Other ADDRESS itl / � � ,' CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,WIT DOSIS Signed S 15 ,' 1�,n1p,L, 1 D/19/18 668622 <br /> WELL DRILLER/AUTHORI280 REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DNR 188 REV 11.07 IF ADDITIONAL SPACE IS NEEDED,USE 1EXT CONSECUTIVELY NUMBERED FORM <br />