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QUADRUPLICATE STATE OF CALIFORNIADWR USE ONLY — DO NOT FILL IN <br /> TI <br /> For Local Requirements WELL COMPLETION "PORT <br /> Page 1 of 2 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95236 No.e0358712 <br /> Date Work Began 11/9/2017 Endedl l/22/2017 — LATITUDE LONGITUDE <br /> Local Permit Agency FnvirenmPntal Health _ f _I I I I I I I I I I I <br /> Permit No. wp0036990 Permit Date 8/3/2017 APN/rRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL _HORIZONTAL —ANGLE —(SPECIFY) Name R&J Dondero <br /> DRILLING ROTARY _ <br /> SURFACEDEPTH FROM METHOD FLUID Mud Mailing Address 20480 E.Co eronQis Rd <br /> DESCRIPTION Linden CA 95236 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 15723 E Hwy 2e ELL LOCATIO <br /> 3 65 Clay City Linden CA 95236 <br /> 65 73 Sand CountySan Joaquin <br /> 73 86 Clay <br /> APN Book Page Parcel <br /> 86 90 Sand Township Range Section <br /> 90 165 Clay Latitude I I <br /> 165 171 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 171 184 Clay LOCATION SKETCH ACTIVITY (✓) <br /> NORTH --V—" NEW WELL <br /> 184 199 Sand MODIFICATION/REPAIR <br /> 199 203 Shale —Deepen <br /> 203 210 Black Sand —Other(Specify) <br /> 210 2301 Clay <br /> DESTROY (Describe <br /> 230 249 Black Sand and Gravel Procedures and Materials <br /> 249 251 Clay Under"GEOLOGIC LOG' <br /> PLANNED USES() <br /> 251 259 Black Sand and Gravel WATER SUPPLY <br /> 259 269 Shale LUDomestic— Pudic <br /> 269 274 Black Sand _v/_ Irrigation — industrial <br /> 274 281 Shale MONITORING— <br /> TEST WELL <br /> 281 284 Black Sand ATHODIC PROTECTION- <br /> 284 290 Shale HEAT EXCHANGE- <br /> 290 294 Black Sand DIRECT PUSH_ <br /> 294 313 Shale INJECTION— <br /> 313 318 Sand VAPOR EXTRACTION <br /> SPARGING_ <br /> 318 327 Clay SOUTH REMEDIATION <br /> 327 331 Black Sand Fences, ve Describe Distance a map.rom Reads, Budlpdings, <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)- <br /> 331 <br /> SPECIFY)_331 340 Shale necessary.PLEASE BE ACCURATE & COMPLETE. <br /> 340 343 Sand and Gravel WATER LEVEL&YIELD OF COMPLETED WELL. <br /> 343 352 Shale DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> 352 378 Black Sand and Gravel DEPTH OF STATIC <br /> 378 407 Shale WATER LEVEL 143 (Ft.)&DATE MEASURED 11/22/2017 <br /> TOTAL DEPTH OF BORING 51 O ESTIMATED YIELD • (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH <br /> TOTAL DEPTH OF COMPLETED WELL 510 (Hrs.) TOTAL DRAWDOWN- (Ft.) <br /> (F�) May not be representative o a well's Ion -term yield <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE !) FROM SURFACE TYPE <br /> DIA y w Z o- MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z T p d GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft. to Ft. m 0 0 a (Inches) THICKNESS (Inches) Ft to Ft. ✓ (✓> �) (TYPE/SIZE) <br /> 0 310 24 STFFI 16 1/4 <br /> 310 510 50 510 RAVE <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,F CORP TION (TYPj OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 Albe Aj Modesto CA 95357 <br /> — Other ADDRESSCITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IFITIX/STS. Signed nVM/z12/11/17 668622 <br /> WELL DRIL UTHO IZED REP E ENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.I1-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CON CUTIVELY NUMBERED FORM <br />