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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 Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95230 No.e0351417 <br /> Date Work Began 8/22/2017 Ended8/28/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Envirnnmeptal Health I I I I I I I I I I I I <br /> Permit No. wp0036988 Permit Date 8/3/2017 APNITRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) V VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Mary Strogen <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud FarmingtonAddress P.O. BOX 141 CA 95230 <br /> _SURFACEDESCRIPTION <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 2 Top SoilWELL LOCATION- <br /> 2 <br /> Address 29876 E Hwy 4 <br /> 2 3 Hard Pan City Farmington CA 95230 <br /> 3 11 Gravel and Rocks <br /> 11 85 Clay CountySan Joaquin <br /> APN Book Page Parcel <br /> 85 931 Blue Sand Township Range Section <br /> 93 1281 Clay Latitude I I <br /> 128 145 Black Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 145 154 Clay LOCATION SKETCH ACTIVITY (-v) <br /> NORTH � NEW WELL <br /> 154 166 Black Sand <br /> 166 210 Clay MODIFICATION/REPAIR <br /> —Deepen <br /> 210 217 Black Sand —Other(Specify) <br /> 217 243 Clay <br /> DESTROY(Describe <br /> 243 245 Black Sand Procedures and Materials <br /> 245 252 Clay Under"GEOLOGIC LOG' <br /> PLANNED USES() <br /> 252 255 Black Sand WATER SUPPLY <br /> 255 260 Clay U ; __x/ <br /> Domestic— Public <br /> 260 274 Black Sand — Irrigation — Industrial <br /> 274 298 Clay MONITORING— <br /> TEST WELL- <br /> 298 302 Black Sand ATHODIC PROTECTION- <br /> 302 313 Clay HEAT EXCHANGE- <br /> 313 318 Sand DIRECT PUSH- <br /> 318 328 Clay INJECTION— <br /> VAPOR EXTRACTION_ <br /> 328 349 Black Sand SPARGING_ <br /> 349 3661 Shale SOUTH REMEDIATION— <br /> Illustrate or Describe Distance of Well from Roads, Buildings, <br /> 366 368 Black Sand Fences,Rivers,etc. and attach a trap. Use additional paper if OTHER(SPECIFY)— <br /> 368 400 Shale <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 STAT�C.�, <br /> WATER LEVEL�(Ft.)&DATE MEASURED 8/28/2017 <br /> TOTAL DEPTH OF BORING 400 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN <br /> (FL) <br /> TOTAL DEPTH OF COMPLETED WELL 355 (Feet) Mav not be representative o a well's long-term yield <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE °) FROM SURFACE TYPE <br /> DIA. Y w o MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Z Z DIAMETER OR WALL IF ANY FILTER PACK <br /> (Inches) p J GRADE MENT TONT FILL <br /> Ft. to Ft. m v LL (Inches) THICKNESS (Inches) Ft. to Ft. (✓) U (TYPE/SIZE) <br /> 0 335 105/8 <br /> 335 355 v .045 106 355 G EL <br /> ATTACHMENTS (✓ ) CERTIFICATION STATEMENT <br /> — Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of m kno vl <br /> y edge and belief. <br /> Well Construction Diagram NAME MASELLIS DRILLING INC <br /> — Geophysical Log(s) (PERSON,FIRM,OR CORPO ON) (TYPED OR PRINTED) Modesto CA 95357 <br /> — Soil/Water Chemical Analysis 119 Albers <br /> — Other ADDRESS t, CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMA770N,lFlTIXsigned 08/31/17 668622 <br /> ISTS. WELL DR A RI EPRE TATIVE DATE SIGNED C57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE N CONSECUTIVELY NUMBERED FORM <br />