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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 NOJ STATION NO. <br /> Owner's Well No. 95366 NO.e0348025 <br /> Date Work Began 7/13/2017 Ended7/14/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health <br /> WP0036801 7/10/2017 APNrrRS/OTHER <br /> Permit No. Permit Date <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL _HORIZONTAL ANGLE —(SPECIFY) Name Jose Villanuava <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 18396 S Wagner Rd <br /> _SURFACEDESCRIPTION Ripon CA 95366 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 01 3 Top SoilAddress 17888 S.Wagner Wj'LOCATIO <br /> 3 5 Hard Pan City Ripon CA 95366 <br /> 5 8 Sand <br /> County San Joaquin _ <br /> 8 281 Clay APN Book Page Parcel <br /> 28 33 Sand Township Range Section <br /> 33 67 Clay Latitude I 1 I <br /> 67 69 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 69 78 Clay LOCATION SKETCH ACTIVITY (✓) <br /> 78 88 Sand NORTH --I(– NEW WELL <br /> MODIFICATION/REPAIR <br /> 88 124 Clay _Deepen <br /> 124 132 Sand —other(Specify) <br /> 132 157 Clay <br /> 157 158 Sand —Procedures(Describe Materials <br /> Under"GEOLOGIC LOG' <br /> 158 200 Clay PLANNED USES() <br /> 200 206 Sand WATER SUPPLY <br /> 206 209 Clay in ; Domestic_ Public <br /> 209 216 Sand Irrigation — Industrial <br /> 216 245 Clay MONITORING— <br /> TEST WELL <br /> 245 247 Sand ATHODIC PROTECTION- <br /> 247 275 Clay HEAT EXCHANGE- <br /> 275 275 Sand DIRECT PUSH_ <br /> 276 295 Clay INJECTION— <br /> VAPOR EXTRACTION— <br /> 295 299 Sand SPARGING_ <br /> 299 307 Clay SOUTH REMEDIATION <br /> 307 308 Sand 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 STAT <br /> WATER LEVEL (FL)8 DATE MEASURED 7/14/2017 <br /> TOTAL DEPTH OF BORING 308 ESTIMATED YIELD • (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 255 (Feet) Mav not be representative of a well's lon -term yield. <br /> DEPTHCASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HORS a:T�YPE _!L FROM SURFACE TYPE <br /> DIA. MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) GRADE DIAMETER OR WALL IF ANY MENT TONI FILLFILTER PACK <br /> Ft. to Ft. (Inches) THICKNESS (Inches) Ft. to Ft. (✓) U (TYPEISIZE) <br /> 0 200 14 <br /> 200 220 ✓ 100 255 � RAVEL <br /> 220 235 <br /> 235 255 <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,FIR OR CORPORAT ) (TYPED R PRINTD) <br /> — Soil/Water Chemical Analysis 1 fb Modesto <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed07/24/17 668622 <br /> WELL DRILL AU H IZ PRES 0 4 ATIVE t, DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />