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QUADRUPLICATE STATE OF CALIFORNIADWR 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. 95304 No.e0372208 <br /> Date Work Began 5/16/2019 Ended5/16/2019 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health <br /> Permit Permit No. w 0039585 it Date W5/6/2019 APTRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) �L VERTICAL —HORIZONTAL ANGLE —(SPECIFY) Name Michael Armer <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 8740 Vine Ln. <br /> SURFACE <br /> DESCRIPTION Tracy CA 95304 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top SOiI WELL LOCATION <br /> 3 60 Gravel&Rock Address 8891 Palmauist <br /> Rd <br /> 60 86 Clay City Tracy CA 95304 <br /> 86 110 Gravel County San Joaquin <br /> APN Book Page Parcel <br /> 110 113 Clay Township Range Section <br /> 113 116 Gravel Latitude � I I <br /> 116 128 ClayDEG. MIN. SEC. DEG. MIN. SEC. <br /> 128 143 Gravel LOCATION SKETCH ACTIVITY (✓) <br /> NORTH --V—' NEW WELL <br /> 143 150 Clay <br /> MODIFICATION/REPAIR <br /> 150 176 Gravel —Deepen <br /> 176 246 Clay —Other(Specify) <br /> 246 248 Sand <br /> DESTROY (Describe <br /> 248 260 Clay Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> 26266 Sand PLANNED USES(-L) <br /> 2666 325 Clay F WATER SUPPLY <br /> W Domestic— Public <br /> 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 Roadv, Buildings, <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)— <br /> necessary. PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVE�L�&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER 325 (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STATIC <br /> WATER LEVEL 86 (Ft.)&DATE MEASURED 5/16/2019 <br /> TOTAL DEPTH OF BORING 325 ESTIMATED YIELD 'TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> (GPM)& TEST TYPE <br /> (Feet) <br /> TOTAL DEPTH OF COMPLETED WELL 280 (Feet) May not be representative of a well's long-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 o °' GRADE DIAMETER OR WALL IF ANY FILTER PACK <br /> Ft. to Ft. g v Inches THICKNESS (Inches) Ft. to Ft. MENT TONITJ FILL <br /> m <br /> CID LL <br /> (inches) ✓ (✓) (✓) (TYPE/SIZE) <br /> 0 260 105/8 <br /> 260 280 206 280 GRAVEL <br /> ATTACHMENTS (4) 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,FI OR CORPORATION) (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 Albe- Rel k I I Modesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IFITIXISTS. 11 Signed , 06/11/19 668622 <br /> WELL DRIL AUTHORIZED IREPRESt4ATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT cONSECKTIVELY NUMBERED FORM <br />