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DUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> Driller's Copy WELL COMPLETION REPORT <br /> Page I of I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95231 No.e0367538 I ❑ I I I I ❑ <br /> Date Work Began Ended LATITUDE LONGITUDE <br /> Local Permit Agency EnvirnnmPntal Health _ _ I I I I I I I I I I <br /> Permit No. wp0038345 Permit Date 5/29/2018 APWTRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Nocetti Farms _ <br /> DRILLING Mailing Address P.O. BOX 340 <br /> SURDEPTH <br /> FROM METHOD DESCRIPTION FLUID g <br /> French Camp CA 95231 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> Address 1010 Madruga WELL LOCATION <br /> City Lathrop CA 95330 <br /> County San Joaquin <br /> APN Book Page Parcel <br /> Township Range Section <br /> Latitude I 1 I <br /> DEG. MIN. SEC. DEG. MIN. SEC. <br /> LOCATION SKETCH ACTIVITY (✓) <br /> NORTH — NEW WELL <br /> MODIFICATIONIREPAIR <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 /> — <br /> 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 1 <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft.)&DATE MEASURED <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING (Feet) TEST LENGTH <br /> (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL (Feet) M not be representative o a well's lon -term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE ITYPE FROM SURFACE TYPE <br /> DIA• w a MATERIAL/ INTERNAL GAUGE SLOT SIZECE- BEN- <br /> (Inches) It1 OaGRADE DIAMETER OR WALL IF ANY FILTER PACK <br /> FI. to Ft. L v LL (Inches) THICKNESS (Inches) Ft. to Ft. M�T T�I FAL (TYPE/SIZE) <br /> (—) (_) — <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> — Geologic Log 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 I TED) <br /> — Soil/Water Chemical Analysis 119 Albers RModesto CA 95357 <br /> — Other ADDRESS llkliiwCITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed06/26/18 668622 <br /> WELL DRILLER/AUTHO D REPRyENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />