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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT STATE wELLNaIsrAnoN W. <br /> Page 1 of l Refer to lnctnrc•rrnn Pamphlet (—_ <br /> Owner's Well No. 95215 No'e0278521 i <br /> Date Work Began 7/22/2015 I:nded <br /> $!7/2015 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health — 1 I I I I I I I -L-! <br /> APN/rRS/OTHER <br /> Permit No. 72136 Permit Date <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION ✓—VERTICAL —HORIZONTAL — ANGLE —(SPECIFY) Name Moorman's Water Systems <br /> DRILLING Ma <br /> ROTARY Mud Mailing Address 2120UN).X_f3d- <br /> METHOD FLUID — CA 95215 <br /> DEPTH FROM DESCRIPTION Stockton_ <br /> FL to FL Describe material, groin, size, color, eta CITY STATE ZIP <br /> v�ELL LOCATIO <br /> 0; <br /> 3:Top Soil Address 9332E Fairchild Ra <br /> 3: 8:Clay City Stokton CA <br /> 8 35:Sand and Gravel _ Co,u,tySan Joaquin _ <br /> M' 68 Clay — APN Book Page Parcel <br /> 68: 80:Sand and GravelIr. Township_ Range Section <br /> 80: 123:Clay Latitude I <br /> 123; 124 i Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> LOCATION SKETCH ACTIVITY V) <br /> 1_24 140 Clay_ AUG ---- NORTH - --- V" NEW WELL <br /> 1401 141 Sand MODIFICATIOWREPAIR <br /> 141 151 ;Clay —° " <br /> 151; 162;Sand ENVIRONMENTAL HEAL? —Dinar(Spedty) <br /> 162'183;Clay PERMIPSERVICESi <br /> DESTROY(Describe <br /> 183: 184:Sand_ _ __ uhaer"GEOLOGIC Loc" <br /> 184~ 257:Clay _ PLANNED USES(V-) <br /> 257: 258:SandWATER SUPPLY <br /> Domestic— PtbYe <br /> 258: 323:Clay Q V/ Imgalion _ IndiBMel <br /> 323 328:Sand $ w MONITORING -- <br /> 328 333:Clay - - - -- - --_ TEST WELL— <br /> 333 340Sandy Clay ATHODIC PROTECTION- <br /> 340. 347 Clay -- - <br /> DIRECT PUSH_ <br /> — - HEAT EXCHANGE— <br /> DIRECT <br /> 347 34_8 Sand <br /> INJECTION — <br /> 348 383 Clay _ _ VAPOR EXTRACTION — <br /> 383 401 Black-Broom Sand SPARGING <br /> 401 . 440 Clay SOUTH - REMEDIATION._ <br /> lllusnore m l kscnbe Dtsmnce of Wdl fian Road,. Buildings. <br /> 440 i 442 Sand Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY) <br /> — — <br /> necessary. PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER-- - (Ft.)BELOW SURFACE <br /> DEPTH OF STATIC 7/23/2014 <br /> - - — — WATER LEVEL- 118 --(Ft.)&DATE MEASURED --- ---- - <br /> - - ESTIMATED YIELD ' — (GPM)& TEST TYPE — <br /> TOTAL DEPTH OF BORING 442 (Fed) TEST LENGTH (Hrs.) TOTAL DRAWDOWN _ (FL) <br /> TOTAL DEPTH OF COMPLETED WELL 41 O (Feet) AfeW not be representative o a well's long-term yield. <br /> DEPTH I BORE- CASING(S) ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE �) FROM SURFACE TYPE <br /> -- DIA Y W a MATERIAL l INTERNAL GAUGE SLOT SIZE CE, BEN <br /> Z w zQ a LTER PACK <br /> DIAMETER OR WALL IF ANY FL to FL �T TON FILL FI <br /> (inches) pcat GRADE <br /> Ft to FL m 0 U� LL (Inches) THICKNESS (Inches) (�) V) <br /> 0: 370 14 V PLA IC -- 8, - 0 70 <br /> — <br /> 370: 410 2 - AM _ <br /> ATTACHMENTS (r ) CERTIFICATION STATEMENT <br /> Geologic Log I,the undersgned,certify that this report is complete and accurate to the best of my knowledge and belief. <br /> Well Constriction Diagram NAME MASELLIS DRILLING INC _ <br /> Geophysical Log(s) (PERSON M,OR CORP TION(TYP D OR PRINTED) <br /> -- SaVWater Chenucal Analysis --- 0- <br /> -- Other ... ADDRESS CITY STATE �'P <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 15 <br /> WELL ORILLER/AUTH I REP ENTATIVE DATEATE StiI C�D C-67 LICENSE NUMBER <br /> DWR 198 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE N CONSECUTIVELY NUMBERED FORM <br />