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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. 95366 No-e0339665 <br /> Date Work Began 4/6/2017 Ended4/17/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Envirorimpritni Health I I I I I I I I I I I I <br /> Permit No. 76207 Permit Date 11/14/2016 APNITRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) V VERTICAL —HORIZONTAL — ANGLE —(SPECIFY) Name Jane Weststeyn <br /> DRILLING NARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address P.O. BOX 1273 <br /> DESCRIPTION Ripon CA 95366 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 2 Top SoilELL LOCATIO <br /> 2 20 Sand Address 10707 E.West Ipon <br /> 20 43 Sand <br /> City Ripon CA 95366 <br /> 43 47 Sand County San Joaquin <br /> APN Book Page Parcel <br /> 47 78 Clay Township Range Section _ <br /> 78 92 Sand Latitude 1 1 1 <br /> 92 105 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 105 120 Sand LOCATION SKETCH ACTIVITY ) <br /> NORTH __V_1' NEW WELL <br /> 120 127 Clay <br /> MODIFICATION/REPAIR <br /> MODI <br /> 127 133 Sand —Deepen <br /> 133 143 Clay —Other(Specify) <br /> 143 148 Sand <br /> 148 153 Clay DESTROY <br /> Ys a0nd Materials <br /> Under"GEOLOGIC LOG' <br /> 153 163 Sand PLANNED USES() <br /> 163 248 Clay WATER SUPPLY <br /> 248 252 Sand w ; Domestic— Public <br /> 252 260 Clay Industrial <br /> Irrigation — <br /> � � <br /> 260 261 Sand MONITORING— <br /> TEST WELL— <br /> 261 264 Clay ATHODIC PROTECTION- <br /> 264 265 Sand Streak HEAT EXCHANGE- <br /> 265 280 Clay DIRECT PUSH__ <br /> 280 282 Sand INJECTION <br /> VAPOR EXTRACTION —_ <br /> 282 293 Clay SPARGING_ <br /> 293 298 Sand SOUTH REMEDIATION_ <br /> 298 328 Clay Illustrate or Describe Distance of Well from Roads, Buildings, <br /> y Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY) <br /> 328 332 Sand oecastry. PLEASE BE ACCURATE & COMPLETE. <br /> 332 355 Brown Clay WATER LEVEL&YIELD OF COMPLETED WELL <br /> 3551 3801 Blue Clay DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> DEPTH OF STATIC <br /> WATER LEVEL 40 (Ft.)&DATE MEASURED 4/10/2017 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 380 —(Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 340 (Feet) Mav not be representative o a well's lon -term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIL A <br /> FROM SURFACE HB ORLE TYPE ✓ FROM SURFACE TYPE <br /> DIA. z w f na—. MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) o GRADE DIAMETER OR WALL IF ANY FILTER PACK <br /> Ft. to Ft. g p Ft o Ft. MENT TONT FILL <br /> m LL (Inches) THICKNESS (Inches) (TYPE/SIZE) <br /> 0 140 21 v PLASTIC 12 2nn 0 54 V <br /> 140 1804 <br /> 180 240 . 54 340 VEL <br /> 240 340 <br /> ATTACHMENTS (y) 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) (PERSO C. R TIO INTED) <br /> — Soil/Water Chemical Analysis 119 Albers 7 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF ITDCISTS. I Signed v 05/10/17 668622 <br /> WELL DRILLER/AUTH D REP ENTATI(/E DATE SIGNED C57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />