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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT FET I I I <br /> Page 1 of I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95356 NO.e0343627 I I ❑ ❑ <br /> Date Work Began 5/16/2017 Ended6/1/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmenatl Health I T-1 I I I I I I I I I <br /> Permit No. Permit Date <br /> 75403 8/4/2016 APNrfRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL HORIZONTAL — ANGLE —(SPECIFY) Name Frank Borges <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 1518 Thunder Bird Rd <br /> SURFACEDESCRIPTION Modesto CA 95356 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 4 Top Soil Address 8350 Brady Rd WELL LOCATION <br /> 4 8 Hard Pan City Manteca CA <br /> 8 9 Sand County San Joaquin <br /> 9 38 Clay APN Book Page Parcel <br /> 38 64 Sand <br /> 64 72 Clay Township Range Section <br /> Latitude I1 <br /> 72 82 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 82 115 Clay LOCATION SKETCH ACTIVITY (✓) <br /> NORTH —,/— NEW WELL <br /> 115 130 Sand <br /> 130 143 Clay MODIFICATIDOQWRtEPAIR <br /> 143 164 Sand —Other(Specify) <br /> 164 173 Clay <br /> 173 177 Sand — DESTROY and Materials <br /> 177 194 Clay Under"GEOLOGIC LOG' <br /> PLANNED USES() <br /> 194 200 Sand <br /> WATER SUPPLY <br /> 200 208 Clay F; Domestic — Public <br /> 208 230 Sand —v� Irrigation _ Industrial <br /> 230 240 Shale MONITORING— <br /> TEST WELL— <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH— <br /> INJECTION_ <br /> VAPOR EXTRACTION— <br /> JAN 201SPARGING— <br /> SOUTH <br /> Illustrate or DescriAe Distance oJWell from Roads, Buildings. REMEDIATION— <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)— <br /> l,N V I II\ necessary. PLEASE BE ACCURATE & COMPLETE. <br /> DEPARTNi WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> DEPTH OF STAT C <br /> WATER LEVEL 26 (Ft.)&DATE MEASURED 5/18/2017 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 240 (Feet) TEST LENGTH <br /> (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 240 (Feet) Mav not be representative of a well's long-term yield. <br /> DEPTHCASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓) FROM SURFACE TYPE <br /> DIA c w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z O aJ GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Fl. to Ft. (n v (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) �) (TYPE/SIZE) <br /> 0 200 21 <br /> 200 240 100 240 � GRAVEL <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,FIRCORPORAT (TYP O I TED) <br /> — Soil/Water Chemical Analysis 11 I 'x Modesto CA 7 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed VMrw06/01/17 668622 <br /> WELL DRILLER/AUTHORIZE RESE TIVE I DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />