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QUADRUPLICATE STATE OF CALIFORNIA <br />For Local Requirements WELL COMPLETION REPORT <br />Page 2 of 2 Refer to Instruction Pamphlet <br />Owner's Well No. 95236 No. e0354327 <br />Date Work Began 10/5/2017 , Ended10/16/2017 <br />Local Permit Agency Envimnmental Health <br />Permit No. wp0036991 Permit Date 8/3/2017 <br />GEOLOGIC LOG <br />ORIENTATION (✓) V VERTICAL — HORIZONTAL — ANGLE —(SPECIFY) <br />DRILLING ROTARY <br />DEPTH FROM METHOD FLUID Mud <br />RFACE I DESCRIPTION <br />t. to Ft. Describe <br />408 411 Shale <br />411 418 Black Sand <br />418 424 Shale <br />424 446 Black Sand <br />446 483 Shale <br />483 499 Black Sand <br />499 5061 Shale <br />506 5101 Black Sand <br />510 5301 Clay <br />530 545 Black Sand <br />545 555 Shale <br />555 574 Black Sand <br />574 580 Shale <br />TOTAL DEPTH OF BORING 580 (Feet) <br />TOTAL DEPTH OF COMPLETED WELL 580 (Feet) <br />color, etc. <br />DWR UUE VNLY — UO NOT FILL IN <br />STATE WELL NO./ STATION NO. <br />LATITUDE LONGITUDE <br />APNITRS/OTHER <br />WELL OWNER <br />Name Calosso Dondero Investments <br />Mailing Address 20480 E. CoR e�ropolis Rd <br />Linden CA 95236 <br />CITY STATE ZIP <br />Address 23757 E Chris Ln ELL LOCATIO" <br />City Linden CA 95236 <br />County San Joaquin <br />APN Book Page Parcel <br />Township Range Section <br />Latitude II <br />DEG. MIN. SEC. DEG. MIN. SEC. <br />LOCATION SKETCH—ACTIVITY (✓) — <br />NORTH -AL NEW WELL <br />DEPTH BORE - <br />FROM SURFACE HOLE <br />DIA. <br />(inches) <br />Ft. to Ft. <br />MODIFICATION/REPAIR <br />DEPTH <br />FROM SURFACE <br />— Deepen <br />TTYPE ✓) <br />a MATERIAL / INTERNAL GAUGE SLOT SIZE <br />J GRADE DIAMETER OR WALL IF ANY <br />v (inches) THICKNESS (Inches) <br />— Other (Specify) <br />_ DESTROY (Describe <br />Procedures and Materials <br />400 580 <br />Under "GEOLOGIC LOG' <br />50 580 <br />PLANNED USES() <br />WATER SUPPLY <br />~ <br />u) <br />Domestic _ Public <br />Q <br />Irrigation — Industrial <br />LLI <br />MONITORING — <br />TEST WELL — <br />ATHODIC PROTECTION— <br />HEAT EXCHANGE— <br />DIRECT PUSH— <br />INJECTION — <br />VAPOR EXTRACTION _ <br />SPARGING <br />— <br />REMEDIATION <br />SOUTH <br />Illustrate or Describe Distance of Well from Roads, Buildings, <br />— <br />Fences, Rivers, etc. and attach a map. Use additional paper if <br />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 STATIC <br />152.6 10/16/2017 <br />WATER LEVEL (Ft.) & DATE MEASURED <br />ESTIMATED YIELD ' (GPM) & TEST TYPE <br />TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br />DEPTH BORE - <br />FROM SURFACE HOLE <br />DIA. <br />(inches) <br />Ft. to Ft. <br />CASING (S) <br />DEPTH <br />FROM SURFACE <br />ANNULAR MATERIAL _ <br />TYPE <br />CE- BEN - <br />MENT TONIT FILL FILTER PACK <br />✓ (✓) U (TYPEISIZE) <br />TTYPE ✓) <br />a MATERIAL / INTERNAL GAUGE SLOT SIZE <br />J GRADE DIAMETER OR WALL IF ANY <br />v (inches) THICKNESS (Inches) <br />Ft. to FL <br />0 400 24 <br />✓ <br />400 580 <br />.080 <br />50 580 <br />-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 R +q <br />— Other ADDRESS <br />ATTACH ADDITIONAL INFORMATION, IF IT EXISTS. Signed <br />WELL DRILLPMR <br />DWR 188 REV. 11-97 IF ADDITIONAL SPACE IS NEEDED, USE NEXT <br />CITY <br />.Y NUMBERED FORM <br />STATE ZIP <br />