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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 Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95215 No.e0368067 I LID I I I I I ❑ <br /> Date Work Began 7/10/2018 Ended7/11/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Fnvirnnmental Health I L I I I I I I I <br /> Permit No. wp0038513 Permit Date 7/6/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -,/-VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Moormans Water Systems <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 2120 Wilcox Rd <br /> SURFACEDESCRIPTION Stockton CA 95215 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 1 Top Soil Address 11220 E Hwy 12WELL LOCATION-- <br /> 1 11 Hard Pan City Lockeford CA <br /> 11 75 Clay CountySan Joaquin <br /> 75 771 Sand APN Book Page Parcel <br /> 77 84 Clay Township Range Section <br /> 84 88 Sand Latitude i 1 1 <br /> 88 116 Clay DEG. MIN. SEC, DEG. MIN. SEC. <br /> 116 118 Sand LOCATION SKETCH ACTIVITY (✓) <br /> 118 148 Clay <br /> NORTH �L NEW WELL <br /> 148 152 Sand MODIFICATIONIREPAIR <br /> —Deepen <br /> 152 160 Clay —other(Specify) <br /> 160 168 Sand <br /> 168 184 Clay <br /> DESTROY <br /> (Describe <br /> and Ma erials <br /> 184 190 Sand Under"GEOLOGIC LOG' <br /> PLANNED USES() <br /> 190 223 Clay <br /> WATER SUPPLY <br /> 223 233 Sand co — Domestic Public <br /> 233 248 Clay — Irrigation _ Industrial <br /> 248 255 Sand MONITORING— <br /> TEST WELL <br /> 255260 Clay ATHODIC PROTECTION- <br /> 260 262 Sand HEAT EXCHANGE- <br /> 262 312 Clay DIRECT PUSH- <br /> 312 320 Sand INJECTION— <br /> 320 340 Clay VAPOR ExTPARGNG— <br /> SOUTH REMEDIATION— <br /> 1/1-in'te 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- 124 (Ft.)8 DATE MEASURED 7/11/2018 <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 325 (Feet) May not be representative of a well's long-term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE- a51jE .!L)HOLE FROM SURFACE TYpE <br /> DIA. MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. to Ft. (Inches) GRADE DIAMETER OR WALL IF ANY MENT TONIT FILLFILTER PACK <br /> (Inches) THICKNESS (Inches) Ft to Ft. ✓ ✓ ✓ (TYPE/SIZE) <br /> to <br /> (_) U _ <br /> 0 305 12 <br /> 305 325 204GRAVEL <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,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 IT EXISTS. Signed 07/11/18 668622 <br /> WELL DRILLER/AUTHORIZF,D--REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />