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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page I of I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. �I <br /> Owner's Well No. #5 WELL No.2018-006840 111 , 1 1 <br /> Date Work Began 7/31/2018 Ended8/16/2018 LATITUDE LONGITUDE <br /> Local Permit Agency SAN.IOAQIIIN COUNTY I I I I I I I I <br /> W P0038310 5/23/2018 APNrrRS/OTHER <br /> Permit No. Permit Date <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -L VERTICAL HORIZONTAL — ANGLE —(SPECIFY) Name TRACY GRANITE CONSTRUCTIO <br /> DRILLING <br /> DEPTH FROM METHOD REVERSE FLUID g Mailin Address 37400 S BIRD RD <br /> SURFACE DESCRIPTION TRACY CA 95304 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0; 30;ROCKS/CLAY Address BIRD RD.&BLENHM64TI0 <br /> 30: 40:CLAY <br /> City CA <br /> 40:. 45:ROCKS/CLAY <br /> 45: 50;CLAY County SAN JOAQUIN <br /> 50: 1301 ROCK APN Book 265 Page 080 Parcel 15 <br /> 130; 162:ROCK&SAND IENTAL H TpIship Range Section <br /> atitude 37 36 718 N 121 20 603 W <br /> 1621 177:SANDY CLAY i)EpARTNIENT DEG. MIN. SEC. DEG. MIN. SEC, <br /> 477: 380:ROCK LOCATION SKETCH ACTIVITY (✓) <br /> 3801 387 I CLAY NORTH __v/_ NEW WELL <br /> 3871 420;ROCK eletveP�� MODIFICATION/REPAIR <br /> Deepen <br /> 420:, 430:SANDY CLAY —Other(Specify) <br /> 430; 780:ROCKS/CLAY <br /> — DESTROY(Describe <br /> 780: 805:CLAY Procedures and Materials <br /> 805: 813:GRAVEL Under"GEOLOGIC LOG' <br /> PLANNED USES() <br /> 813: 831 :CLAY WATER SUPPLY <br /> 831 : 840:ROCK rn — Domestic— Public <br /> 840: 861 :CLAY �/n%�� — Irrigation :C Industrial <br /> 861 : 1020;SANDY CLAY W/ROCKS MONITORING TEST WELLWELL— <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 <br /> DEPTH OF STATIC <br /> WATER LEVEL (Ft.)&DATE MEASURED <br /> TOTAL DEPTH OF BORING 1 O2O ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 1 OOO (Feet) Mav not be representative o a well's lou -term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓ FROM SURFACE PE <br /> DIA. Y w z a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z O aJ GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft to Ft. m v <br /> in <br /> I.A. <br /> (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) �) (TYPE/SIZE) <br /> 0: 50 44" ✓ ✓ 11 SACK SLUR <br /> Oi 270 " ✓ 11 SACK SLUR <br /> 0: 360 28" STEEL 1 "O 3/8" 250 1020 1/4 X 10 GPS <br /> 360! 1000 28" V STEEL 16"OD 3/8" FF.090 <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 MYERS BROS.WELL DRILLING. INC. <br /> — Geophysical Log(s) (PERSON,FIRM,OR CORPORATION) (TYPED OR PRINTED) <br /> — Soil Water Chemical Analysis P.O.B041983 HANFORD CA 93232 <br /> — Other ADDRESSVI CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. I Signed el" Lan08/16/18 548214 <br /> WELL DRILLER/AUTHORIZED RWRESrNTATKIE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT WNSECUTIVELY NUMBERED FORM <br />