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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 1 Refer to Instruction Pamphlet STATE WELLNO./STATION NO. <br /> Owner's Well No. 95215 No.e0365028 ❑ ❑ <br /> Date Work Began 4/4/2018 Ended4/5/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmenatl Health I I I I I I I I I I I I l <br /> Permit No.wp0037996 permit Date 2/28/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER -- <br /> ORIENTATION(✓) al 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 2 Top SoilAddress 29020 N. JackTone Kd OCATto <br /> 2 22 ClayGalt CA 95632 <br /> 22 30 Gravel City <br /> 30 37 Clay County San Joaquin <br /> APN Book Page Parcel <br /> 37 43 Gravel Township Range Section <br /> 43 761 Clay Latitude i 1 1 <br /> 76 78 Gravel DEG. MIN. SEC. DEG. MIN. SEC. <br /> 78 90 Clay LOCATION SKETCH ACTIVITY ) <br /> 90 94 Sand NORTH -.%/— NEW WELL <br /> MODIFICATION/REPAIR <br /> 94 157 Clay —Deepen <br /> 157 167 Gravel —other(Spey) <br /> 167 218 Clay <br /> 218 223 Sand — DESTROY(Describe <br /> Matenals <br /> Under"GEOLOGIC LOG' <br /> 223 238 Clay PLANNED USES(.) <br /> 238 243 Sand WATER SUPPLY <br /> 243 2621 Clayn __1ZDomestic— Public <br /> Lij 262 266 Sand — Irrigation — Industrial <br /> 266 278 Clay MONITORING— <br /> TEST WELL_ <br /> 278 280 Sand ATHODIC PROTECTION_ <br /> 280 283 Olay HEAT EXCHANGE- <br /> 283 285 Sand DIRECT PUSH_ <br /> 285 293 Clay INJECTION_ <br /> VAPOR EXTRACTION— <br /> 293 315 Sand SPARGING- <br /> 315 396 Clay SOUTH REMEDIATION_ <br /> Illustrate or Describe Distance of Well from Roads, Buildings, <br /> 396 408 Sand Fences,Rivers,etc. and attach a rap. Use additional paper if OTHER(SPECIFY)- <br /> 408 412 Clay necessary.PLEASE BE ACCURATE & COMPLETE. <br /> 412 4481 Sand and Gravel WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> DEPTH OF STA 166 4/5/2018 <br /> WATER LEVEL (Ft.)&DATE MEASURED <br /> TOTAL DEPTH OF BORING 448 ESTIMATED YIELD (GPM)& TEST TYPE <br /> ' <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 415 (Feet) M not be representative o a well's Ion -term yield. <br /> DEPTH PORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE -) FROM SURFACE TYPE <br /> DIA. i a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Irtches) p a GRADE DIAMETER OR WALL IF ANY MENT TONI FILL FILTER PACK <br /> Ft. to Ft. m o U (Inches) THICKNESS (Inches) Ft to Ft (TYPE/SIZE) <br /> m tT ✓ (✓) (✓) <br /> 0 395 105/8 <br /> 395 4151 1 1 .045 1 RAVEL <br /> I <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> — Geologic Log I,the undersigned,certify that this report is complete and accurate to the beat of my knowledge and belief. <br /> Well Construction Diagram NAME MASELLLS DRILLING LWC <br /> — Geophysical Log(s) (PERSON,F R T N),(rWED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 Albers Rd Modesto CA 95357 _ <br /> — Other ADDRESSCITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. 11 Signed 04/09/18 668622 <br /> WELL DRILLER/AUTHORI REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.I1-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />