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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 I Refer to Instruction Pamphlel STATE WELL NO./STATION NO. <br /> Owner's Well No. 95236 NO.e0366508 I I I I IT]i ❑ <br /> Date Work Began 5/17/2018 Ended5/21/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health 1 1-1 1 1 1 1 1 1 1 1 1 1 <br /> Permit No. wp0038204 Permit Date 5/1/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL _HORIZONTAL —ANGLE —(SPECIFY) Name Drew Chaney <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address P.O. BOX 555 <br /> DESCRIPTION Linden CA 95236 <br /> _SFACEFt. to Ft. Describe material grain, size, color, etc. CITY STATE ZIP <br /> Top SOII LL LOCATIO <br /> 0 4 Address 2430 N. Murray U <br /> 4 48 To <br /> Cit,Linden CA 95236 <br /> 48 58 Gravel and Rocks County,San Joaquin <br /> 58 64 Rocks <br /> 64 127 Clay APN Book Page Parcel <br /> Township Range Section <br /> 127 131 Gravel Latitude 1 1 <br /> 131 180 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 180 182 Sand LOCATION SKETCH ACTIVITY �) <br /> 182 187 Clay NORTH --VL NEW WELL <br /> MODIFICATION/REPAIR <br /> 187 204 Sand —Deepen <br /> 240 220 Clay —Other(Specify) <br /> 220 221 Sand <br /> 221 229 Clay — DESTROY <br /> aOnd Mat rials <br /> Under"GEOLOGIC LOG' <br /> 229 246 Sand PLANNED USES() <br /> 246 266 Clay WATER SUPPLY <br /> 266 268 Sand Domestic— Public <br /> 268 298 Clay Irrigation — Industrial <br /> 298 300 Sand MONITORING— <br /> TEST WELL— <br /> 300 303 Clay ATHODIC PROTECTION- <br /> 303 304 Sand HEAT EXCHANGE- <br /> 304 355 Clay 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 /> neceanry.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_ <br /> EVEL 14"4' (Ft.)&DATE MEASURED 5/21/2018 <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 355 (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 275 (Feet) I May not be representative o a well's long-term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BOLE TYPE ✓) FROM SURFACE TYPE <br /> DIA• 1 w a MATERIAL 1 INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. to Ft. (Inches) g ir Zp J GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> to v (Inches) THICKNESS (Inches) Ft. to Ft. (TYPE/SIZE) <br /> to T (✓) (✓) <br /> 0 235 105/8 <br /> 235 275 -GRAVEL <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 OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 Albers Rd Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF ITEXISTS. 11 Signed 06/05/18 668622 <br /> WELL DRILLER/AUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />