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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. 95240 No.e0368077 <br /> Date Work Began 7/24/2018 Ended7/25/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health _ _ I I I I I I I I I__LI <br /> Permit No. wp0038546 Permit Date 7/13/2018 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL —HORIZONTAL — ANGLE _(SPECIFY) Name Donald Keller <br /> DRILLING <br /> DEPTH FMETHOD Mud Mailing Address 11950 N. H99 <br /> RFA ROTARY <br /> ROM FLUID <br /> Lodi CA 95240 <br /> Ft. to Ft. Describe material, grain, sue, color, etc. CITY STATE ZIP <br /> 01 2 Top Soil Address 11950 N Hwy 99WELL LOCATIO <br /> 2 8 Sand City Lodi CA 95240 <br /> 8 143 Clay <br /> 143 162 Sand County San Joaquin <br /> APN Book Page Parcel <br /> 162 1801 Clay Township Range Section <br /> 180 1881 Sand Latitude I I t _ <br /> 188 232 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 232 247 Sand LOCATION SKETCH ACTIVITY �✓) <br /> NORTH --Y/— NEW WELL <br /> 247 262 Clay <br /> MODIFICATION/REPAIR <br /> 262 268 Sand —Deepen <br /> 268 269 Clay —other(Specify) <br /> 269 273 Sand <br /> DESTROY(Describe <br /> 273 274 Clay Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> 274 278 Sand PLANNED USES() <br /> 278 302 Clay WATER SUPPLY <br /> 302 304 Sand y Domestic— Public <br /> 304 323 Clay — Irrigation — Industrial <br /> 323 331 Sand MONITORING— <br /> TEST WELL— <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 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 1 <br /> DEPTH OF STATIC <br /> WATER LEVEL 92 (Ft.)&DATE MEASURED 7/25/2018 <br /> TOTAL DEPTH OF BORING 331 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 312 (Feet) May not be representative o a well's loo -term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL. <br /> FROM SURFACE HOLE TSE �) FROM SURFACE TYPE <br /> DIA. Y W a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- <br /> Ft. to Ft, (Inches) g p GRADE DIAMETER OR WALL IF ANY MENT TONT FILL FILTER PACK <br /> in <br /> m v (Inches) THICKNESS (Inches) Ft. to Ft. (rYPE/SIZE) <br /> (✓) W <br /> 0 292 12 <br /> 292 312 .045 204 312GRAVEL <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,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 =' 08/03/18 668622 <br /> 11 WELL DRILLERIAUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 198 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />