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QUADRUPLICATE STATE OF CALIFORNIA OWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 1 of 1STATE WELL NO./STATION NO. <br /> Refer to Inarncrion /'amphlcr <br /> Owner's Well No. 95366 No.774116 �.. I I i.�_I I�E <br /> Date Work Began 11/7/00 , Endedl l/10/00 LATITUDE LONGITUDE <br /> Local Permit Agency Public Health S -rvi -aa <br /> Permit No. 24485 Permit Date 11/6/00 APN/TRS/OTHER <br /> GEOLOGIC LOG —-- — <br /> 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 /> RFA E DESCRIPTION mon CA 95366 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY WELL STATE ZIP <br /> 0 6,Soil Address 23245 S.Austin BELL LOCATIO <br /> 6 _ 12:Sand - _- on CA <br /> Rip_ <br /> 12 40 Clay&Sand Streaks City ity Rip an-Joaquin <br /> 40 46 Sand _ - — <br /> 46 84 Clay - -- APN Book Page _ Parcel <br /> 84 90 Sand Township Range _Section <br /> Latitude_ <br /> 90 140 Clay _ DEG. MIN. SEC. DEG. MIN SEC. <br /> 140 144 Sand — LOCATION SKETCH ACTIVITY (�) <br /> 144 150 Clay ✓ NEW WELL <br /> 150 163 Coarse Sand MODIFICATIONIREPAIR <br /> -Deepen <br /> 163 190 Clay _Dow(Specify) <br /> 190 196 Coarse Sand <br /> 196 235 ClayDESTROY(Describe <br /> Procedures and Materials N <br /> Under"GEOLOGIC LOG' U) <br /> PLANNED USES(,z) t� <br /> WATER SUPPLY H <br /> ✓ �w_4 <br /> Domestic_ Public <br /> S ¢ Irrigation _ Industrial 1 n <br /> f 3 ul MONITORING.— ") <br /> TEST WELL <br /> ATHODIC PROTECTION_ <br /> HEAT EXCHANGE— <br /> DIRECT PUSH <br /> INJECTION <br /> VAPOR EXTRACTION _ <br /> SOUTH <br /> SPARGING _ <br /> _ <br /> /UumMe or DearlheW.srancrofWellJ�rmrRrurlt /luilJirrytx. REMEDIATION <br /> Fences.Riven,etc. and anach a map. Use additional paper if OTHER(SPECIFY)_ \ <br /> necessary. PLEASE BE ACCURATE. & CODIPLETF. (� <br /> WATER LEVEL&YIELD OF COMPLETED WELL !Vl' <br /> DEPTH TO FIRST WATER— (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STAT C <br /> - WATER LEVEL__—.6_ —_ <br /> (Ft.)8 DATE MEASURED 11/10/00 <br /> TOTAL DEPTH OF BORING 235 ESTIMATED YIELD ' (GPM)& TEST TYPE _ <br /> (Feet) TEST LENGTH__ Mrs.) TOTAL DRAWDOWN (FL) <br /> TOTAL DEPTH OF COMPLETED WELL205 (hect) May not be representative ofa well's long-term yield. <br /> DEPTHBORE- DEPTH CASING(S) ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE �) FROM SURFACE TYPE <br /> DIA Y w =cd T a a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BE I FILTER PACK <br /> (Inches) o GRADE DIAMETER OR WALL IF ANY MENT TON FILL (TYPE/SIZE) <br /> Ft. to Ft. m N v o _1 (Inches) THICKNESS (Inches) Ft. to Ft (✓ <br /> u. <br /> 0, 185 14 pLA,9TIC8 100 160 0 108 <br /> 185; 205 ✓ 108 205 `J GRAVEL <br /> ATTACHMENTS (r l 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,OR CORPORATION) (TYPED OR PRINTED) <br /> Soil/Water Chemical Analysis 119 Albers Rd.00 Modesto _ _ CA 95357 <br /> Other ADDRESS , �®� � CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION.IF IT EXISTS Signed ----C11� Llid�r u _ — 11/15/00_ 8622 <br /> LL DRILLER/AUTH IZE REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV 11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />