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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. 95337 No.e0372193 <br /> Date Work Began 3/15/2019 Ended3/29/2019 LATITUDE LONGITUDE <br /> Local Permit Agency Fnvirnnmpntal Health <br /> Permit No. wp0038790 Permit Date 9/20/2019 APN/rRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(!) -L-VERTICAL _HORIZONTAL ANGLE —(SPECIFY) Name Cornelius DeRuyter <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 6625 Avenue D <br /> SURFACEDESCRIPTION Manteca CA 95337 <br /> Ft to Ft Describe material, grain, size, color, etc. CITE' STATE ZIP <br /> 0 31 Top Soil Address 26338 Manteca' 'NLL LOCATIO <br /> 3 8 Sand City Manteca CA 95337 <br /> 8 33 Clay County San Joaquin <br /> 33 48 Sand APN Book Page Parcel <br /> 48 60 Clay Township Range Section <br /> 60 63 Sand Latitude I 1 <br /> 63 103 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 103 111 Sand LOCATION SKETCH ACTIVITY (✓_) <br /> 111 115 Clay <br /> NORTH --I/- NEW WELL <br /> MODIFICATION/REPAIR <br /> 115 124 Sand —Deepen <br /> 124 130 Clay —Other(Specify) <br /> 130 138 Sand <br /> — DESTROY (Describe <br /> 138 147 Clay Procedures and Materials <br /> 147 185 Sand Under"GEOLOGIC LOG" <br /> PLANNED USES() <br /> 185 197 Clay WATER SUPPLY <br /> 197 200 Sand v~i t- Domestic— Pudic <br /> 200 218 Clay Irrigation — Industrial <br /> 218 229 Sand MONITORING— <br /> TEST WELL <br /> 229235 Blue Clay ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH— <br /> INJECTION— <br /> VAPOR EXTRACTION <br /> SPARGING_ <br /> SOUTH REMEDIATION— <br /> Illustrate or Describe Distance of We!/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 <br /> DEPTH OF STATIC <br /> WATER LEVEL 11.2 (Ft.)&DATE MEASURED 3/29/2019 <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 235 (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 230 (Feet) May not be representative of a well's loft -term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓) FROM SURFACE <br /> DIA. Y w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z w aJ GRADE DIAMETER OR WALL IF ANY FILTER PACK <br /> Ft. to Ft. to p MENT TON FILL <br /> v LL (Inches) THICKNESS (Inches) Ft. to FL ✓ (✓) �) (TYPE/SIZE) <br /> 0 130 24 V STF=FI 16 114 0 50 V <br /> 130 230 0 230 � RAVE <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 CORPO ION) (TYPED JR PRINTED) <br /> — Soil/Water Chemical Analysis 119 AI95357 <br /> — Other ADDRESSCITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMAPON,IF IT EXISTS. Signed 04/24/19 668622 <br /> WELL DRIL AUTHORI D REPREtEj4TATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> Dox 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSE UTIVELY NUMBERED FORM <br />