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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT l I l l l l l l <br /> Page 1 of I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95236 No.e0361487 I I 1 1:1111 1 1 1 1 1 1❑ <br /> Date Work Began 1/17/2018 Endedl/19/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health _ I I I I I I I I I I t__1 <br /> Permit No. wp0037764 Permit Date 1/3/2018 APNIPRSIOTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(V) VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Joseph Sanquinetti <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD DESCRIPTION ION FLUID Mud Mailing Address 18626 Cop�oolis Rd <br /> Linden CA 95236 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 18626 Copper000 s h&OCATIO <br /> 3 12 Clay City Linden CA 95236 <br /> 12 14 Gravel CountySan Joaquin <br /> 14 60 Clay APN Book Page Parcel <br /> 60 80 Gravel Township Range Section <br /> 80 127 Clay Latitude I I I <br /> 127 195 Shale DEG. MIN. SEC. DEG. MIN. SEC. <br /> 195 200 Sand LOCATION SKETCH ACTIVITY (✓) <br /> 200 2361 Shale NORTH ---,/ NEW WELL <br /> MODIFICATION/REPAIR <br /> 236 244 Sand —Deepen <br /> 244 246 Shale(Lost Circ) —Other(Speck) <br /> 246 254 Gravel <br /> 254 325 Shale — DESTROY (Describe Materials <br /> Under"GEOLOGIC LOG' <br /> 325 331 Black Sand PLANNED USESO <br /> 331 340 Shale WATER SUPPLY <br /> ~ _-Z Domestic— Public <br /> Q Irrigation _ Industrial <br /> ul 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 WeB 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 144 (Ft.)&DATE MEASURED 1/19/2018 <br /> TOTAL DEPTH OF BORING ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN <br /> (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 340 (Feet) Mav not be representative of a well's loo -term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓> FROM SURFACE TYPE <br /> DIA. Y w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z w O a GRADE DIAMETER OR WALL IF ANY ME NT TONT FILL FILTER PACK <br /> Ft. to Ft, m v (Inches) THICKNESS (Inches) Ft. to Ft. (TYPEISIZE) <br /> rn LL ✓ (d) (✓) <br /> 0 240 11 <br /> 240 260 .045 1 -GRAVEL <br /> 260 320 <br /> 320 340 <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, RATIO PEp R 4 <br /> — Soil/Water Chemical Analysis 119 AlbersR IIIA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signer 01!19/18 668622 <br /> WELL DRILLER/AUTHORIZED AWESENTAMVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 198 REV.1I-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />