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QUADRUPLICATE STATE OF CALIFORNIA <br />For Local Requirements WELL COMPLETION REPORT <br />Page 1 of I Refer to Instruction Pamphlet <br />Owner's Well No. 95230 No. e0351418 <br />Date Work Began 8/28/2017 Ended8/30/2017 <br />Local Permit Agency FnvirpnmPnatl Hpalth <br />Permit No. wp0037047 Permit Date 8/8/2017 <br />GEOLOGIC LOG <br />ORIENTATION (✓) <br />DEPTH FROM <br />SURFACEDESCRIPTION <br />FL to Ft. <br />V VERTICAL — HORIZONTAL — ANGLE —(SPECIFY) <br />DRILLING ROTARY <br />METHOD FLUID Mud <br />Describe material, grate, sue, color, etc. <br />0 <br />3 <br />Top Soil <br />3 <br />35 <br />Clay <br />35 <br />40 <br />Sand and Gravel <br />40 <br />44 <br />Clay <br />44 <br />51 <br />Sand and Gravel <br />51 <br />112 <br />Clay <br />112 <br />115 <br />Sand <br />115 <br />121 <br />Clay <br />121 <br />127 <br />Sand <br />127 <br />136 <br />Clay <br />136 <br />142 <br />Sand <br />142 <br />145 <br />Clay <br />145 <br />148 <br />Sand <br />148 <br />163 <br />Clav <br />1 1861 2091 Shale <br />2091 230 1 Sand and Gravel <br />1 2331 2441 Sand and Gravel <br />2861 291 Sand <br />2911 295Clay <br />2951 297 Sand <br />TOTAL DEPTH OF BORING 315 (Feet) <br />TOTAL DEPTH OF COMPLETED WELL 300 (Feet) <br />Name Howard Steif <br />Mailing Address_E,S <br />DWR USE ONLY — DO NOT FILL IN <br />STATE WELL NO./ STATION NO. <br />LATITUDE LONGITUDE <br />APN/TRS/OTHER <br />WELL OWNER <br />Farmington <br />CA 95230 <br />CITY <br />STATE ZIP <br />Address 19663 OakwoodVAveL LOCATION' <br />City Stockton CA 95215 <br />INTERNAL GAUGE SLOT SIZE <br />D(IInches) R OR WALL IF HCK ESS (In hes <br />County San Joaquin <br />Ft. to Ft. <br />APN Book Page Parcel <br />Ft to Ft. <br />Township Range Section <br />0 280 <br />Latitude t <br />I <br />DEG. MIN. SEC. <br />DEG. MIN. SEC. <br />LOCATION SKETCH --�—ACTIVITY <br />() — <br />NORTH <br />L NEW WELL <br />SOUTH <br />Illustrate or Describe Distance of Well from Roads, Buildings, <br />Feces, Rivers, etc. and attach a map. Use additional paper if <br />necessary. PLEASE BE ACCURATE & COMPLETE. <br />MODIFICATION/REPAIR <br />— Deepen <br />— Other (Specify) <br />— DESTROY (Describe <br />Procedures and Materials <br />Under "GEOLOGIC LOG, <br />PLANNED USES(---) <br />WATER SUPPLY <br />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 />REMEDIATION <br />OTHER (SPECIFY)— <br />WATER LEVEL & YIELD OF COMPLETED WELL <br />DEPTH TO FIRST WATER (Ft.) BELOW SURFACE <br />DEPTH OF STATIC <br />WATER LEVEL 136 (Ft.) & DATE MEASURED — <br />ESTIMATED YIELD " (GPM)8 TEST TYPE_ <br />TEST LENGTH (Hrs-) TOTAL DRAWDOWN <br />8/30/2017 <br />(Ft.) <br />DEPTH <br />FROM SURFACE <br />BORE - <br />HOLE <br />DIA• <br />(Inches) <br />CASING (S) <br />DEPTH <br />FROM SURFACE <br />ANNULAR MATERIAL <br />nTYPE_!L) <br />MATERIAL I <br />GRADE <br />INTERNAL GAUGE SLOT SIZE <br />D(IInches) R OR WALL IF HCK ESS (In hes <br />TYPE <br />Ft. to Ft. <br />Ft to Ft. <br />CE- BEN - <br />MENT TONT FILL FI(�YPE/SIZ )K 0) (� ) <br />0 280 <br />11 <br />280 300 <br />5 <br />100 <br />A 11 1AUHMENTS (,.) 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, FIV, <br />ROR I N) E ED) <br />— Soil/Water Chemical Analysis 11 AI e R `uodesto <br />— Other ADDRESS8� CITY <br />ATTACH ADDITIONAL INFORMATION, IF IT EXISTS. Signed ' 08/31/17 <br />jI WELL DRILLER/AUTHORI2D`'REPRES TATIVE DATE SIGNED <br />DWR 188 REV. I1-97 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />STATE ZIP <br />NUMBER <br />