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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 I Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95215 No.e0369880 I I I 1 1:101 1 1 1 1 1 10 <br /> Date Work Began 11/19/2018 Endedl 1/20/2018 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I I I I I I I I I I <br /> Permit No. wp0038318 Permit Date 5/23/2018 APN/TRS/OTHER <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 /> SURFACEDESCRIPTION Stockton CA 95215 <br /> Ft. to Ft. Describe material grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil Address 22401 Hwy 26 WELL LOCATIO <br /> 3 17 Clay City Linden CA <br /> 17 43 Rocks County San Joaquin <br /> 43 107 Clay APN Book Page Parcel <br /> 107 124 Gravel Township Range Section <br /> 124 138 Clay Latitude I I 1 <br /> 138 188 Black Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 188 198 Clay LOCATION SKETCH ACTIVITY �) <br /> �C <br /> 198 202 Black Sand NORTH NEW WELL <br /> 202 2481 ClayMODIFICATIONIREPAIR <br /> —Deepen <br /> 248 264 Black Sand —other(Specify) <br /> 264 269 Clay <br /> — <br /> DESTROY(Describe <br /> 269 271 Black Sand Procedures and Materials <br /> Under"GEOLOGIC LOG" <br /> 271 273 Clay PLANNED USES() <br /> 273 281 Black Sand WATER SUPPLY <br /> 281 296 Clay 3 ¢ �[ Irrigation Ir _ Indstic— ustrial <br /> trial <br /> 296 297 Black Sand ul <br /> 297 308 Clay MONITORING— <br /> TEST WELL— <br /> 308 364 Black Sand ATHODIC PROTECTION- <br /> 364 368 Clay HEAT EXCHANGE- <br /> 368 373 Gravel Set up DIRECT PUSH- <br /> 373 378 Clay INJECTION— <br /> VAPOR EXTRACTION— <br /> 378 405 Black Sand <br /> SPARGING— <br /> 405 410 Clay SOUTH REMEDIATION— <br /> Illustrate or Describe Distance of Well from Roads, Buildings, <br /> 410 450 Black Sand Fences,Rivers,etc. and attach a map. Useadditional paper if OTHER(SPECIFY)_ <br /> 450 490 Clay necessary. PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> DEPTH OF STATIC 11/20/2018 <br /> WATER LEVEL 66 (Ft.)&DATE MEASURED <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 490 (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL447 (Feet) May not be representative o a well's lon -term yield. <br /> DEPTH _ 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 /> (Inches) Z w p n. GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Fl. to Ft. m 0 v LL (Inches) THICKNESS (Inches) Ft to Ft. ✓ (✓) �) (TYPE/SIZE) <br /> 0 347 21 PLASTIC 12 200 0 56 <br /> 347 447 V, .045447 GRAVEL <br /> ATTACHMENTS (g) CERTIFICATION STATEMENT <br /> — Geologic Log I,the undersigned,certify that this report is complete and accurate to the hest 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 INFORMA710N,IF IT ExiST& Signed 11/21/18 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 />