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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Loci Requirements WELL COMPLETION REPORT <br /> Page 1 of 2 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95320 NO.e0366503 <br /> Date Work Began 4/23/2018 Ended4/30/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Fnvirnnmpntal Health I I I I I I I I I I I <br /> Permit No. wp0037980 Permit Date 2/27/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL —HORIZONTAL ANGLE —(SPECIFY) Name DeRuosi Nut <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID MUD Mailing Address 25055 Arthur Rd <br /> SURFACEDESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 25068 E.Arthur KciLL LOCATIO <br /> 3 10 Shale City Escalon CA 95320 <br /> 10 25 Sand County San Joaouin <br /> 25 39 Clay APN Book Page Parcel <br /> 39 43 Sand and Gravel Township Range Section <br /> 43 79 Clay Latitude I 1 <br /> 79 85 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 85 96 Clay LOCATION SKETCH ACTIVITY L) <br /> 96 112 Sand and Gravel NORTH __V_1' NEW WELL <br /> MODIFICATION/REPAIR <br /> 112 119 Clay —Deepen <br /> 119 123 Sand —Other(specify) <br /> 123 127 Clay <br /> 127 133 Sand — DESTROY <br /> (Describe <br /> a0nd M aerials <br /> Under"GEOLOGIC LOG' <br /> 133 175 Clay PLANNED USES() <br /> 175 179 Sand WATER SUPPLY <br /> 179 205 Clay u~i U) Domestic Public <br /> 205 209 Sand Irrigation _ Industrial <br /> 209 217 Clay MONITORING— <br /> TEST WELL- <br /> 217 220 Sand ATHODIC PROTECTION- <br /> 220 247 Clay HEAT EXCHANGE- <br /> 247 250 Sand DIRECT PUSH_ <br /> 250 258 Clay INJECTION—. <br /> VAPOR EXTRACTION— <br /> 258 261 Sand SPARGING <br /> 261 267 Shale SOUTH REMEDIATION <br /> 267 276 Sand Illustrate or Describe Distance of Well from Roads, Buildings, <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)- <br /> 276 294 Clay <br /> necessary. PLEASE BE ACCURATE & COMPLETE. <br /> 294 297 Sand WATER LEVEL&YIELD OF COMPLETED WELL <br /> 297 321 Clay DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> 321 329 Sand and Gravel DEPTH OF STAT <br /> 329 344 Clay WATER LEVEL (Ft.)&DATE MEASURED 5/22/2018 <br /> TOTAL DEPTH OF BORING 460 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL460 (Feet) Wav not he representative of a well's long-term yield. <br /> DEPTH "ORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TSE > FROM SURFACE TYPE <br /> DIA. Y w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z K p MENT TONIT FILL <br /> a GRADE DIAMETER OR WALL IF ANY FILTER PACK <br /> Ft. to FL m N o LL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) U (TYPE/SIZE) <br /> 0 180 26 STFFL 16 1/4 0 100 <br /> 180 460 100 460 GRAVEL <br /> ATTACHMENTS (✓ ) CERTIFICATION STATEMENT <br /> — Geologic Log 1,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,,"M,OR CORPO TION) (TYPD OR PRINTED) <br /> — Soil/water Chemical Analysis 119 Albers 1V9 p ra°4 d[110l`�a Modesto CA 95357 <br /> Other <br /> ADDRESS S s= CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF/T DCISTS. Signed 06/04/18 668622 <br /> 11 WELL DRILLER/AUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV-I1-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />