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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 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95320 No.e0367525 I ❑ I I I 1 0 <br /> Date Work Began 5/31/2018 Ended6/1/2018 _ LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health <br /> Permit No. wp0038344 Permit Date 5/29/2018 APNIfRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) --.L VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Ron&Sue Mostwoski <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 28401 Orange Ave. <br /> SURFACEDESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 5 Top Soil Address 28401 Orange AVE LL LOCATIO <br /> 5 10 Hard Pan City Escalon CA 95320 <br /> 10 20 Sand CountySan Joaquin <br /> 20 25 Clay <br /> APN Book Page Parcel <br /> 25 30 Sand <br /> 30 38 Clay Township Range Section <br /> Latitude r 1 r <br /> 38 501 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 50 56 Clay LOCATION SKETCH ACTIVITY (✓) <br /> NORTH -/ NEW WELL <br /> 56 58 Gravel <br /> 58 75 Sand MODIFICATION/REPAIR <br /> —Deepen <br /> 75 90 Clay —Other(Specify) <br /> 90 108 Sand <br /> — DESTROY (Describe <br /> 108 156 Clay Procedures and Materials <br /> 156 163 Sand Under"GEOLOGIC LOG" <br /> PLANNED USES([) <br /> 163 228 Clay WATER SUPPLY <br /> 228 230 Sand Domestic Public <br /> — Irrigation _ Industrial <br /> 230 267 Clay <br /> 267 268 Sand MONITORING— <br /> TEST WELL- <br /> 268 277 Clay ATHODIC PROTECTION- <br /> 277 281 Sand Streaks HEAT EXCHANGE- <br /> 281 293 Clay DIRECT PUSH- <br /> 293 303 Sand INJECTION— <br /> VAPOR EXTRACTION— <br /> 303 34O Clay 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 (FL)BELOW SURFACE <br /> DEPTH OF STATIC, 6/1/2018 <br /> WATER LEVEL- (Ft.)&DATE MEASURED <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 340 (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 310 (Feet) May not be representative o a well's long-term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓) FROM SURFACE TYPE <br /> DIA. 1 W a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z W o a GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> Ft. to Ft. m a v LL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) �) (TYPE/SIZE) <br /> 0 290 12 PLASTic 6 200 p 204 <br /> 290 310 204 310 rPAVF:l <br /> F-_ <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> — Geologic Log 1,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,FIRAMAAoQR CORPORAT ) (TYPEDPRINTr�) <br /> — Soil/Water Chemical Analysis 1 CA <br /> 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT IJCISTS. Signed 06/05/18 668622 <br /> 11 WELL DRILLERIAUTHORIZ PRESE ATIVE If DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />