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ORIGINAL STATE OF CALIFORNIA <br />FlIa'With DWR WELL COMPLETION REPORT <br />ppage I of 1 1 Refer to Instruction ponepbles <br />Owner's Well No. 0 /9 07/24/97 No- 532827 <br />Date Work 7/217 ,Ended <br />Local Permit ATn;6 <br />Permit 69 - Permit Date <br />4F -Y ­­ T <br />C'. <br />�y <br />LATITUDE LONQffUDE <br />WAWJ W"LU "VU <br />x <br />ORIENTATION (4) VERTICAL ® HMZONrAL — ANGLE — (SPECIFY) <br />DEM TO FlBff WATER(FL}BELOW SURFACE <br />DEM FROM <br />SURFACE DESCRIPTION <br />FL to Ft. Dacribe material sin jize, cdar, etc, <br />WELL OCATION <br />ddie'+6 701 joLqktbne Rd. <br />s <br />0 :4 -soil <br />4 12 clay <br />ockt0ii <br />12 :35 Sand & Clay StX,:eake <br />unty San 136aiiuin <br />I ­ <br />I'. <br />kPN Book Page — Parcel <br />35 75"1,: " I'% <br />Cla <br />75 82 ,Sand <br />or <br />1own <br />Tsrap'Range — Section <br />e NQM Longitude <br />DEG. MIN. SEC. <br />I <br />DEQ_ <br />82 :120 ,clayJe' <br />120 :126 : Sand, <br />LOCATION SKETCH <br />ACTIVITY (4) <br />1261-142 -iClay." <br />- <br />NORTH <br />_X New Wei. <br />MODIFICAIMIREPAIR <br />142 e1.46 66'ar 86, 1ga ild, <br />146 :177, :SO-ft*C11jr". <br />t, <br />177 180-, ; 6par:649a. 8And' <br />— Deepen <br />— other (spodfO <br />- <br />� ! ' <br />1 6!Q " 1ji <br />DESTROYMeaMbe <br />PloodifitreamWAffilowlato <br />Mder"WOLOGICLOW7 <br />-PLANNED USES) - <br />_;2A2:,s'cAgliv <br />282 <br />285 296- <br />290 :296_-'Sal3a <br />296 i320 Q rA Y'. <br />(4) <br />MONUOFM40 <br />WATER SUPPLY <br />Domestic <br />X_ Public <br />Irdiiallon <br />IMINstrial <br />.'TEST WELL" <br />SOUTH <br />Illustrate or Dmr& Dblance of Wd? from Landmarks <br />,-h 8"ME-10ldlers <br />gg =AC 16C P <br />OAIHODIO FROTM <br />TION <br />OTHER (Specify) <br />DRILUNG <br />METHOD —ROTARY FLUID, WATER <br />WATER LEVEL & YIELD OF COMPLETED WELL <br />DEPTH OF <br />WATER LEJELTne (Ft.) & DATE MEASURED <br />ESTIMATED YIELD* (GPM) a TEST TYPE <br />TEST LENGTH — (cera.) TOTAL DRAWDOWN — <br />(Ft.) <br />TOTAL DEPTH OF BORING -320 (Feet) <br />TOTAL DEMI OF COMPLETED WELL _30_4_ (Feet) <br />I <br />* May not be Y*rvrentadve of awell'r long -um yield <br />DEPTH BORE- <br />CASING(S) <br />DEPTH ANNULAR MATERIAL <br />TYPE 4 <br />FROM SURFACE HOLE <br />FROM SURFACE <br />TYPE <br />DIA. <br />Onches) <br />Ft. to Ft. <br />MATERIAL/ INTERNAL <br />GRADE DIAMETER <br />Onches) <br />TW <br />GAUGE SLOT SIZE <br />OR WALL IF ANY <br />THICKNESS <br />CE a <br />- EN- <br />MENT TONITE FILL FILTER PACK <br />Onches) <br />Ft. to Ft. <br />(4) (4) <br />(11) (TYPEISIZE) <br />—0 280 14 <br />X1 _21.4611C 8 <br />280 390 <br />1 Ague <br />ATTACHMENTS <br />CERTIFICATION STATEMENT <br />1, the undersigned, certify that this report Is complete and accurate to Ithe,best of my knowledge and belief. <br />— Geologic Log <br />NAME MASELLIS <br />DRILLING. INC. <br />— Well Constriction Diagram <br />Pl, HRK OR CORPORATION) (TYPED OR PRIMED) <br />— Geophysical Log(s) <br />— Sod/Water Chemical Analyses <br />119 Albers <br />Rd. Modesto <br />es <br />CA 95357 <br />AWKW <br />CRY <br />A" N_ <br />,_ Other <br />ATTACH ADDMONAL INFORMATIOM IF IT EMM. <br />07/30/97. 668622 <br />J <br />11 RR LER <br />RFS TA S7 <br />DATE /3 <br />C-5 LICENSE-AUMBER <br />DWR 188 REV. 7.90 IF ADDJTIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />1 <br />