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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT =1 I I I I I I I L <br /> Page I of 1 Refer to hinniction Pomplilet STATE WELLNO./STATION NO. <br /> Owner's Well No. 95366 No 0937023 � l I I 17 rr <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 81_4/2.006 APWTRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓_) VERTICAL _HORIZONTAL —ANGLE —(SPECIFY) Name FredrikS Nursery - <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 23223 S Austin Rd <br /> — SURFACE DESCRIPTION Ripon CA 95366 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0: 3;Soil Address 23245 S.Austin%LL LOCATiO <br /> 3! 7 Sand City Ripon CA <br /> 7: 28 Clay CountySan Joaquin - - <br /> 28 33 Sand APN Book_ Page _ Parcel — <br /> 33 73'Clay Township Ran a ____ Section <br /> 73: 77 Sand Latitude I <br /> 77: 105 Clay DEG. MIN. SEC. DE—G. MIN SEC, <br /> 1051 110 Sand LOCATION SKETCH ACTIVITY (✓) <br /> 110 117 Clay NORTH -3C NEW WELL <br /> MODIFICATION/REPAIR <br /> 117; 121 Sand Deeper, <br /> 121; 160 Clay other(Specify) <br /> 160; 165:Sand <br /> 165:, 177:Clay PrEocedur s escrib <br /> aDnd and v <br /> Under"GEOLOGIC LOG-Q t <br /> 177: 190:Sand PLANNED USES() !�/ <br /> 190: 230 i Clay WATER SUPPLY <br /> 230:_ 235:Blue Clay __-Z Domestic— Pubic <br /> Irrigation Intlustnal <br /> MONITORING— <br /> TEST WELL— <br /> _ ATHODIC PROTECTION <br /> — <br /> HEAT EXCHANGE— <br /> DIRECT PUSH_ <br /> INJECTION— <br /> VAPOR EXTRACTION— <br /> SPARGING_ <br /> - —-- — SOUTH - REMEDIATION_ <br /> /llaetrate to/h uribr Distmxv of Well from RtxxLs, Rxildirn}, <br /> Fences,Rive?etc. and attach a map. Use additional paper if OTHER(SPECIFY)_ <br /> ii c iisry. PLEASE BE ACCURATE. & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER—""--- (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STAT C <br /> WATER LEVEL 4__-__..._____ Ft)&DATE MEASURED 8/9/2006 <br /> — — "---"---- ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 235 (Feet) TEST LENGTH <br /> (His.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL203 (Feet) Mav not he representative o a hell's long-term Itteld. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ! FROM SURFACE TYPE <br /> DIA. x MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- I BEN- <br /> (Inch") au a GRADE DIAMETER OR WALL IF ANY MENTITONITE FILL FILTER PACK <br /> Ft. to FL m y v LL (Inches) THICKNESS (Inches) FL to Ft �Vj (V) L (TYPE/SIZE) <br /> -0: 163 14 V PLASTIC 160 _Q_ 100 <br /> 163: 203GRAVEL <br /> ATTACHMENTS CERTIFICATION STATFNIENT <br /> Geologic Log I.the undersigned,certify that this repon 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,OR CO ORATION)(TYPED OR PRINTED) <br /> Soiltwater Chemical Analysis 119 Albers Rd. -Modesto CA ,95357 <br /> Other ADDRESS r - ''I ^I CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF/T EXISTS. Signed -- — ��-C�/i�l 08/22/06TEiGN 6686?2 <br /> WELL DRILLER/A R ED REP ESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.I t-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />