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QUADRUPLICATE STATE OF CALIFORNIADWR USE ONLY — DO NOT FILL IN _ <br /> For Local Requirements WELL COMPLETION REPORT I I I I I 1 i I I I <br /> Page 1 of 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95320 NO.e0368100 <br /> Date Work Began 9/13/2018 Ended9/14/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health <br /> Permit No. wp0038547 Permit Date 7/13/2018 APNITRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) –v VERTICAL —HORIZONTAL — ANGLE —(SPECIFY) Name Louise Spurgeon <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 16909 S.Van Allen Rd <br /> SURFACEDESCRIPTION Escalon CA 95320 <br /> Ft. to FL Describe material, grain, size, color, etc. CIT'/ STATE ZIP <br /> 0 3 Top SoilAddress 16909 S Van Allen hb LOCATIo <br /> 3 17 Sand Cit,Escalon CA 95320 <br /> 17 31 Clay <br /> 31 72 Sand CountySan Joaquin <br /> APN Book Page Parcel <br /> 72 150 Clay Township Range Section <br /> 150 171 Sand Latitude � I I <br /> 171 191 Cela DEG. MIN. SEC. DEG. MIN. SEC. <br /> 191 194 Sand LOCATION SKETCH ACTMTY (✓) <br /> 194 209 Clay <br /> NORTH _jL NEW WELL <br /> 209 210 Sand MODIFICATION/REPAIR <br /> —Deepen <br /> 210 240 Clay —other(Specify) <br /> — DESTROY(Describe <br /> Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> PLANNED USESO <br /> WATER SUPPLY <br /> H _1K Domestic— Public <br /> W Irrigation — Industrial <br /> 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 Raads, 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 STATC 9/14/2018 <br /> WATER LEVEL (Ft)&DATE MEASURED <br /> TOTAL DEPTH OF BORING 240 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN <br /> (Ft_) <br /> TOTAL DEPTH OF COMPLETED WELL 220 (Feet) May not be representative o a well's long-term yield <br /> DEPTHOCASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HORLE aT�PEi-Q FROM SURFACE TYPE <br /> DIA• MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) GRADE DIAMETER OR WALL IF ANY MENT TONIT FILLFILTER PACK <br /> Ft. to Ft. (Inches) THICKNESS (Inches) Ft to Ft. ✓ (✓) L) (TYPE/SIZE) <br /> 0 190 11 <br /> 190 220 .045 100 `� GRAVEL <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,FIRMi,OR CORPORA ) (TYPED OR PRINTED) <br /> — SoiVWater Chemical Analysis 119 Albers Rd Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 09/28/18 668622 <br /> WELL DRILLER/AUTHORIZED REPRESENTATIVE DATE SIGNED C57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />