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1. <br /> QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY - DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 1 of 1 Refer fn Gawniclion paniphlel STATE WELLNO./STATION NO. <br /> Owner's Well No. 95366 "°0937023 I�y_ Li F1 <br /> Date Work Began 8/8/2006 Ended8/22/2006 LATITUDE LONGITUDE <br /> Local Permit Agency FnvirnnmPntal Health �_1-- I 1 1 1 I I I I <br /> 47692 APN/TRS/OTHER <br /> Permit No. Permit Date 8/4/2006 <br /> GEOLOGIC LOG WELL OWNGR <br /> ORIENTATION(✓) v-VERTICAL —HORIZONTAL — ANGLE —(SPECIFY) Name Fredriks Nursery <br /> DRILLING <br /> DEPTH FROM METHOD F32TARY FLUID Mud Mailing Address 23223 S.Austin Rd. __ <br /> SURFACE �] DESCRIPTION Ripon - CA 95366_ <br /> Ft. to Ft. Describe malerial, grain, size, color, etc. CITY STATE ZIP <br /> 0; 3 Soil LL LOCATIO <br /> Address 23245 S. Austin - . <br /> - 3 7:Sand <br /> City Ripon CA <br /> 7: 28 Clay _ CountySan Joaquin <br /> 28; _ 33:Sand APN Book Page—____ Parcel <br /> 33: 73:Clay _ Township _ Range_—_ Section <br /> 73 i 77;Sand Latitude <br /> 77 105:Clay DEG. MIN. SEC. DEG MIN SEC <br /> 105 110 Sand LOCATION SKETCH ACTIVITY (v) <br /> - NORTH -- - - - NEW WELL <br /> 110 117 Clay <br /> 117 121 Sand MODIFICATIONIREPAIR <br /> _ ____ _ -- Deepen <br /> 121 160:Clay Other(Specify) <br /> 160 165:Sand <br /> - - - - -- — DESTROY(Describe 1 <br /> 165 177 Clay ProcedurEOLOGIMaterials <br /> LOG" �l <br /> 177: 190:Sand Under PLANNED USES(z) <br /> 190: 230;Clay F WATER SUPPLY <br /> Domestic— c l <br /> 230: 235;Blue Clay Public <br /> U) _1 <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 /> SOUTH --- REMEDIATION ` <br /> - - ilhrstrate or Lkscrilx Distmrce of Well from RomL%, Buildings. <br /> Fences,Rivers,etcand attach a map. Use additional paper ii OTHER(SPECIFY) <br /> - - - --- -- - -- necessary. PLEASE BE ACCURATE & COMPLETE. _ <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER---- (FL)BELOW SURFACE 1 <br /> DEPTH OF STAT1C 8/9/2006 <br /> - — — - — WATER LEVEL _Z4 (FL)8 DATE MEASURED <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 235 (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN - - (Ft.) <br /> TOTAL DEPTH OF COMPLETED W ELL203 (Feet) May not be representative of a well's los -teen vield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE_��) FROM SURFACE TYPE <br /> DIA Z w MATERIAL INTERNAL GAUGE SLOT SIZE ------- -- CE- BEN- <br /> (inches) p1- a GRADE DIAMETER' OR WALL IF ANY MENTI,TON FILL FILTER PACK <br /> z, <br /> Ft to FL m v (Inches) THICKNESS (Inches) Ft. to Ft. ITYPE/SIZE) <br /> 0:_ 163 14 ./ 160 100 <br /> 163 203 ✓ .04 �_ GRAVEL <br /> ATTACHMENTS 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 /> -_ Well Construction Diagram NAME MASELLIS DRILLING INC. <br /> Geophysical Log(s) (PERSON,FIRM,OJCO ORATION) (TYPED OR PRINTED) <br /> Soil/Water Chemical Analysis 119Albem Rd_ _ ____ _ Modesto CA 95357Other ADDRESS / CITY STATE ZIP <br /> ATTACH ADDITIONAL WFORMATION,IFITIXlSTS. Signed _ 08/22/06 668622 <br /> WELL DRILLER/ ZED REP ESENTATIVE DATE SIGNED G57 LICENSE NUMBER <br /> DWR Ise REV.11.97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />