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QUADRUPLICATE STATE. OF CALIFORNIA DWR USE ONLY — DO NOT FI L IN <br /> For Local Requirements WELL COMPLETION REPORT I i I I 1 I i i <br /> Page I of I Refer to lnstracrion Pamphlet STATE WELL NO.1 STATION NO, <br /> Owner's Well No. 95215 NO.e0345025 11 1 1 1 1][11 1 1 1 1 ❑ <br /> Date Work Began 6/1512017 Ended6/16/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health = I I I I / I I I i l l <br /> Permit No. Permit Date <br /> 77687 6/9/2017 APNrrRS10THER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(!) -+L VERTICAL _HORIZONTAL —ANGLE _(SPECIFY) Name MOOrmans Water Systems <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID MUd Stockton Address 2120 Wilcox Rd CA 95215 <br /> DESCRIPTION <br /> Ft. to Ft. I Descrihe material, grain, size, color, etc. Cm �yg STATE Zip <br /> 0 3 Top Soil Address 4338 N. Homer I^ttl LL LOCATION <br /> 3 58 Clay City Stockton CA 95215 <br /> 58 67 Sand CountySan Joaguin <br /> 67 86 Clay APN Book Page Parcel <br /> 86 93 Gravel Township Range Section <br /> 93 157 Clay Latitude 1 1 1 <br /> 157 162 Gravel DEG. MIN. SEC. DEG. MIN. SEC. <br /> 162 228 Clay LOCATION SKETCH ACTIVITY (✓_) <br /> 228 230 Sand NORTH _iL_ NEW WELL <br /> 230 266 Clay MODIFICATIOWREPAIR <br /> —Deepen <br /> 266 275 Sand —Do-(SPeoiy) <br /> 2751 295 Clay —DESTROY(Descnoe <br /> Procedures and Materiels <br /> Under"GEOLOGIC LOG <br /> PLANNED USES{�) <br /> WATER SUPPLY <br /> Domestic._ Puclic <br /> 5 Q <br /> Iffigabon -� Indtuh'tal <br /> uJ MONITORING— <br /> TEST WELL— <br /> THODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH— <br /> INJECTION— <br /> VAPOR EXTRACTION— <br /> SPARGING— <br /> SOUTH REMEDIATION— <br /> 111ustmM or Describe Dt wnm of WeBfiom Roade, Buikkfi yx, <br /> nd <br /> Fences,Rivem em. aatmch a map.Use addifooai papa if OTHER(SPECIFY)— <br /> aeceaary.PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> DEPTH OF STAT C 6/16/2017 <br /> WATER LEVEL (FL)&DATE MEASURED <br /> TOTAL DEPTH OF BORING 295 ESTIMATED YIELD (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH (Mrs.) TOTAL DRAWDOWN (FL) <br /> TOTAL DEPTH OF COMPLETED WELL280 (Feet) Mav not be remyspuadve ofa well's long-term ykld. <br /> DEPTH BORE- <br /> HOLE <br /> OR£- CASING(S) DEPTH —_ ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓ u FROM SURFACE PE <br /> DIA. y w a MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (in�s) Z iL O o. GRADE DIAMETER OR WALL IF ANY MENT TON/ FILL FILTER PACK <br /> FL to Ft. m U v LL (Inches) THICKNESS (inches) Ft to Ft. (TYpFJSiZE) <br /> (,) (✓) <br /> 0 260 10 518 pLASTic 6 200 0 1 100 <br /> 260 280 1280 GRAVEL <br /> I <br /> ATTACHMENTS (v > CERTIFICATION STATEMENT <br /> — Log 1,the w>darsigned,certify that this report Is complete and accurate to the best of my kr)owledge and belief. <br /> — Well Construction Diagram NAME MASELLIS DRILLING INC _ <br /> — Geoptyalrel Logs) (PERSON,FIRM (TYPE 0 <br /> — SWINater Chemical Analysis 19 Ajbem <br /> Modesto CA 95357 <br /> — Other ADDRESS CIT! STATE ZIP <br /> ATTACH ADDITIONAL INFORMA77ON,JF 17 EXISTS 07/10/17 668622 <br /> 11 WELL DR"I ER(, UTHORIZFD RESE IVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR las REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NE)CT CONSECUTIVELY NUMBERED FORM <br />