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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NQT 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. 95366 No.e0356758 LL 11][11 11 1111E <br /> Date Work Began 10/31/2017 , Endedll/1/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health <br /> Permit No. wp0037380 Permit Date 10/6/2017 APN/TRS/OTHER <br /> GEOLOGIC LOG <br /> WELL OWNER <br /> ORIENTATION(✓) -V VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Michelle&Bruce Rankin <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 17035 Milgeo DR <br /> SURFACEDESCRIPTION Ripon CA 95366 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top SoilWELL LOCATIO <br /> Address 17035 Milgeo Dr <br /> WELL <br /> 8 Sand City Ripon CA 95366 <br /> 8 49 Clay County San Joaquin <br /> 49 53 Sand APN Book Page Parcel <br /> 53 65 Clay Township Range Section <br /> 65 68 Sand Latitude I I I <br /> 68 95 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 95 100 Sand LOCATION SKETCH ACTIVITY (✓) <br /> NORTH -.3L NEW WELL <br /> 100 117 Clay <br /> MODIFICATIONIREPAIR <br /> 117 124 Sand —Deepen <br /> 124 128 Clay —Other(Specify) <br /> 128 139 Sand <br /> — <br /> DESTROY(Describe <br /> 139 148 Clay Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> 148 153 Sand PLANNED USES() <br /> 153 1631 Clay WATER SUPPLY <br /> 163 1661 Sand W Domestic Industrial <br /> Irrigation — <br /> 166 173 Clay <br /> — <br /> 173 209 Sand MONITORINGTEST WELL- <br /> 209 250 Clay 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 STATIC 1111/2017 <br /> WATER LEVEL 44 (Ft.)&DATE MEASURED <br /> TOTAL DEPTH OF BORING 250 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL220 (Feet) May not be representative o a well's lon -term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓) FROM SURFACE TYPE <br /> DIA. Y W a MATERIAL/ INTERNAL GAUGE SLOT SIZE <br /> CE- BEN- <br /> Ft. to Ft. (Inches) g p of GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> 00 a (Inches) THICKNESS (inches) Ft. to Ft. ✓ ✓ ✓ (TYPE/SIZE) <br /> 0 180 14 <br /> 180 220 .045 64 220 G EL <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 0 PRINTED) <br /> — Soil/Water Chemical Analysis 119 Albers Modesto CA 9 357 <br /> Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IFITDCISTS. Signedyamw 11/07/17 668622 <br /> WELL DRILLE R E ESE I DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT MNSECUffVELY NUMBERED FORM <br />