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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page 2 of 2 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> g N e0366503 ❑ ❑ <br /> Owner's Well No. 95320 <br /> Date Work Began 4/23/2018 Ended4/30/2018 _ LATITUDE LONGITUDE <br /> Local Permit Agency Envimnmental Health I I I I I I I I I L <br /> Permit No. wp0037980 Permit Date 2/27/2018 APNrTRS/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 /> R A DESCRIPTION Escalon CA 95320 <br /> R. to Ft. Describe material, grain, size, color, etc. CITY STATE LIP <br /> 344 350 Sand Address 25068 E.ArthurE5LL LOCATION <br /> 350 367 Clay City Escalon CA 95320 <br /> 367 368 Sand CountySan Joaquin <br /> 368 3791 Clay APN Book Page Parcel _ <br /> 379 380 Sand Township Range Section <br /> 380 395 Clay Latitude I 1 I l <br /> 395 397 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 397 435 Clay LOCATION SKETCH ACTIVITY (✓) <br /> NORTH NEW WELL <br /> 435 445 Shale MODIFICATION/REPAIR <br /> 445 446 Sand —Deepen <br /> 446 448 Shale —Other(specify) <br /> 448 454 Sand <br /> 454 460 Shale — DESTROY <br /> (Describe <br /> Dnd Materials <br /> Under"GEOLOGIC LOG" <br /> PLANNED USES(Z) <br /> WATER SUPPLY <br /> U) Domestic— Public <br /> _ Irrigation — Industrial <br /> MONITORING— <br /> TEST WELL— <br /> ATHODIC PROTECTION_ <br /> HEAT EXCHANGE— <br /> DIRECT PUSH— <br /> INJECTION— <br /> VAPOR EXTRACTION— <br /> SPARGING— <br /> SOUTH REMEDIATION— <br /> Illustrate or Describe Distance of Well from Roads, Buildings, <br /> Fences,Rivers,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 <br /> DEPTH OF STAT 5/22/2018 <br /> WATER LEVEL (Ft.)&DATE MEASURED <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 460 (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 460 (Feet) I May not be re resentattve of a well's long-term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE- TYPE �) FROM SURFACE TYPE <br /> HOLE — <br /> DIA. w o MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) w Zp a GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft. to Ft. m ci 6 (Inches) THICKNESS (Inches) Ft. to Fl. (TYPE/SIZE) <br /> 0 180 26 1 1 STPPL 16 1 0 100 ./ <br /> 180 460 0 100 460 � 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,FIRM,OR CORPORATION) (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 Albers Rd a.a s 6, Modesto CA 95357 <br /> Other ADDRESS 755FIP7MCITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF/T EXISTS. 11 Signed 06/04/18 668622 <br /> WELL DRILLER/AUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />