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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. 95215 ND.e0369877 <br /> Date Work Began 11/7/2018 Ended 11/8/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health j I I I I I I I 11 11 <br /> Permit No. wp0038890 Permit Date 10/15/2018 APNITRSIOTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) ---/—VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Moormans Water Systems <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 2120 Wilcox Rd _ <br /> DESCRIPTION Stockton CA 95215 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITYSTATE ZIP <br /> 0 2 Rocks Address 4000 N Escalon e�o1 a QCdATio <br /> 2 5 Shale City Linden CA 95236 R _ <br /> 5 38 Gravel and Rocks County San Joaquin <br /> 38 1981 Clay APN Book Page Parcel <br /> 198 200 Sand Township Range Section <br /> 200 218 Clay Latitude � I I <br /> 218 220 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 220 243 Clay LOCATION SKETCH ACTIVITY (✓) <br /> 243 245 Sand NORTH �C NEW WELL <br /> MODIFICATION/REPAIR <br /> 245 268 Clay —Deepen <br /> 268 287 Gravel Set Up —other(Specify) <br /> 287 293 Clay <br /> 293 320 Black Sand — DESTROY <br /> (Describenerials <br /> Under"GEOLOGIC LOG' <br /> 320 363 Clay PLANNED USES() <br /> 363 388 Black Sand WATER SUPPLY <br /> 388 415 Shale u~i __C Domestic— Public <br /> — Inigation — 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 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 STAT lC <br /> WATER LEVEL L23 (Ft.)&DATE MEASURED 11/8/2018 <br /> TOTAL DEPTH OF BORING 415 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (FL) <br /> TOTAL DEPTH OF COMPLETED WELL 385 (Feet) May not be representative o a well's Ion -term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓) FROM SURFACE TYPE <br /> DIA. y W a MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. to Ft. (Inches) g 00 a GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> m 0 � (Inches) THICKNESS (Inches) Ft to FL (TYPE/SIZE) <br /> to <br /> 0 365 105/8 <br /> 365 385 106 385 GRAVE <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 INFORMADON,IF IT FJCISTS. Signed 11/20/18 668622 <br /> 11 WELL DRILLERIAUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />