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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 1 of 1 Refer to Instruction Pamphlei STATE WELL NO./STATION N0. <br /> Owner's Well No. 95215 No.e0338065 1 7151- ❑ <br /> Date Work Began 3/9/2017 Ended3/10/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Envimnmental Hpalth <br /> Permit No. 76877 Permit Date 3/3/2017 APN/rRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Julie Delucchi <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 1002_S.Jacktone Rd <br /> SURFACEDESCRIPTION Stockton CA 95215 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 2 Top Soil Address 1002 S Jacktone <br /> 8 11 Sand dI L LOCATIO <br /> 2 8 City Stockton CA 95215 <br /> 11 70 ClayCounty San Joaquin <br /> APN Book Page Parcel <br /> 7 76 Sand Township Range Section <br /> 766 77 Clay Latitude I I I <br /> 77 78 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 78 125 Clay LOCATION SKETCH ACTIVITY (✓) <br /> NORTH _1/ NEW WELL <br /> 125 130 Sand <br /> 130 148 Clay MODIFICATION/REPAIR <br /> —Deepen <br /> 148 153 Sand —Other(specify) <br /> 153 170 Clay <br /> 170 175 Sand — DESTROY (Describe <br /> Procedures and Materials <br /> 175 184 Clay Under"GEOLOGIC LOG" <br /> 184 198 Sand and Gravel PLANNED USES() <br /> WATER SUPPLY <br /> 198 236 Clay v~i N —Z Domestic— Public <br /> 236 238 Sand litigation — Industrial <br /> 238 244 Clay MONITORING— <br /> TEST WELL— <br /> 244 246 Sand ATHODIC PROTECTION- <br /> 246 253 Clay HEAT EXCHANGE- <br /> 253 257 Sand DIRECT PUSH- <br /> 257 285 Clay INJECTION_ <br /> TRACTION— <br /> VAPOR EX <br /> 285 289 Sand SPARGING_ <br /> 289 290 Clay SOUTH REMEDIATION— <br /> Illustrate or Describe Distance of Well from Roads, Buildings, <br /> Fences,Rivets,etc. and attach a map. Use additional paper if OTHER(SPECIFY)— <br /> necessary. PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STATIC <br /> WATER LEVEL 120 (Ft.)&DATE MEASURED 3/10/2017 <br /> TOTAL DEPTH OF BORING 290 ESTIMATED YIELD • (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 270 (Feet) I May not be representative of a well's long-term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE > FROM SURFACE E <br /> DIA. y W d MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z p a GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> Ft. to Ft. m 0 v LL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) �) (TYPE/SIZE) <br /> 0 250 12 <br /> 250 270 .045 100 270 IGRAVEL <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,OR CORPORATION (TYPED OR PRINTED) <br /> Soil/Water Chemical Analysis 11 AI A 95357 <br /> ADDRESS <br /> — Other CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed Mulft"1 03/22/17 668622 <br /> WELL DRILL O DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.I1-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXTWNSEC1 NIVELY NUMBERED FORM <br />