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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 in hisowtion Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 94521 NO.e0368099 <br /> Date Work Began 9/11/2018 Ended9/12/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I I I I I I I T—] <br /> Permit No. wp0038756 Permit Date 9/12/2018 1 APN/rRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) --,e-VERTICAL _HORIZONTAL —ANGLE —(SPECIFY) Name Robert Ragland <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 965 Autumn Oak Cir <br /> SURFACEDESCRIPTION Concord CA 94521 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 52 N Patton Rd WELL LOCATIO <br /> 3 17 Clay City Stockton CA 95215 <br /> 17 26 Sand <br /> 26 52 Clay CountySan Joaquin <br /> APN Book Page Parcel <br /> 52 71 Sand Township Range Section <br /> 71 130 Clay Latitude I 1 i <br /> 130 151 Shale DEG. MIN. SEC. DEG. MIN. SEC. <br /> 151 217 Clay LOCATION SKETCH ACTIVITY (✓) <br /> 217 220 Sand NORTH __V/_ NEW WELL <br /> MODIFICATIONIREPAIR <br /> 220 225 Clay —Deepen <br /> 225 231 Sand —Other(Specify) <br /> 231 240 Clay <br /> 240 244 Sand — DESTROY <br /> and Materials <br /> Under"GEOLOGIC LOG' <br /> 244 254 Clay PLANNED USES() <br /> 254 260 Sand WATER SUPPLY <br /> 26 262 Clay ai —,kL Domestic— Public <br /> 262 275 Sand — Irrigation _ Industrial <br /> 275 285 Clay 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 Well from Roads, Buildings, <br /> Fences,Rivers,etcand 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 126 (Ft.)&DATE MEASURED 9/12/2018 <br /> ESTITED YIELD (GPM)8 TEST TYPE <br /> TOTAL DEPTH OF BORING 285 MA ' <br /> (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN <br /> (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL280 (Feet) May not be re resentative o a well's long-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 /> Ft. to Ft. (Inches) g uj Zp aJ GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> m v (Inches) THICKNESS (Inches) Ft o Ft. (TYPE/SIZE) <br /> U) LL ✓ (✓) L) <br /> 0 260 11 <br /> 260 280 200 2 -GRAVEL <br /> t <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.CORPORA't16N) (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 Albers Rd __ __ Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IFITIXISTS. Signed 09/28/18 668622 <br /> 11 WELL DRILLER/AUTHORIZED.REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />