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QUADRUPLICATE STATE OF CALIFORNIADWR USE ONLY - DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT i <br /> Page 1 of 1 Refer to lnctruction Pamphlet STATE WELL NOJ STATION NO. <br /> Owner's Well No. 95212 No.0966537 ❑ <br /> Date work Began 4/16/2007 s EndW5/16/2007 LATITUDE LONGITUDE <br /> Local Permit Agency Enuimnmr+tnial Hes±ith I I I I I I I I I I I I I I <br /> Permit No. 50242Permit Date <br /> 4/12/2007 APN/TRSIOTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION VERTICAL —HORIZONTAL ANGLE (SPECIFY) Name F&S Solan <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 9122 N.Alpine Rd. <br /> DESCRIPTION Stockton CA 95212 <br /> Ft. to FL Describe material, grain. Si]e, color, etc. CITY STATE ZIP <br /> 01 3,To Soil Address 11121 N.A, neWELL LOCATIO <br /> ---- - --------1 -- <br /> 1 ' la Stockton CA <br /> - - -- City — - _ <br /> 11 1 141 Sand County San Joaquin <br /> 14; 50;Clay APN Book Page_ Parcel <br /> 50i 55;Sand <br /> 55� 75�Clay Township. Range Section _ <br /> Latitude <br /> 751 88-Sand DEG. MIN. SEC DEG MIN SEC <br /> 88 92'Clay —— LOCATION SKETCH ACTIVITY L) <br /> 921 96'Sand NORTH —f— NEW WELL <br /> 961 100'Clay MODIFICATION/REPAIR <br /> y -- Deepen <br /> 100' 110'Sand - Other(Specty) C. <br /> 110' 155'Clay <br /> __ DESTROY(Describe155' 162'Sand Unded"tGEOLOGCMaterials <br /> Under LOG" <br /> 162; 165;Clay PLANNED FISES(A0 <br /> 165; 170;Sand WATER SUPPLY <br /> 170; 190;Clay �m coDomestic— Public <br /> 1 - 5 < --x/ Irrigation — Industrial190, 195,Sand ul — <br /> 1951 202,Clay MONITORINGTEST WELL_ <br /> 202 205,Sand THODIC PROTECTION- <br /> 2051 288;Clay HEAT EXCHANGE- <br /> 2881 2971 Sand Black DIRECT PUSH_ <br /> 2971 3001 Clay INJECTION— <br /> 3001 310;Sand Brown VAPOR EXTRACTION_ <br /> SPARGING <br /> 3101 3171 Clay SOUTH - REMEDIATION_ <br /> Rhxmte ar tkacWhe Dlatmux of Wellf—Roads. Rw/J�n1�. <br /> 317 1 323,Sand Black Fences,Rivers,etc. end attach a map Use additional paper i f OTHER(SPECIFY)_ <br /> 3231 340 1 Clay <br /> accessary. PLEASE BE ACCURATE & COMPLETE. <br /> I 1 WATER LEVEL&VIELD OF COMPLETED WELL <br /> 1 DEPTH TO FIRST WATER--------.(Ft.)BELOW SURFACE <br /> -- _- - DEPTH OF STAT C 4/23/2007 <br /> ' - ----- ---- -- - - - -- WATER LEVEL <br /> i (FI)8 DATE MEASURED <br /> ESTIMATED YIELD (GPM)& TEST TYPE __ __ <br /> TOTAL DEPTH OF BORING 340 (Feet) TEST LENGTH---(Hrs.) TOTAL DRAWDOWN (Ft) <br /> TOTAL DEPTH OF COMPLETED WELL33 (Feet) A/cry not be representative n a iaell's long-term weld. <br /> DEPTH BORE- CASING(S) DEPTH ANNUI_4R MATERIAL <br /> FROM SURFACE HOLE TYPE FROM SURFACE PE <br /> CIA. tZu n MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Irtches) Z Zp a GRADE DIAMETER OR WALL IF ANY MENT TON FILL FILTER PACK <br /> Ft. to Ft, <br /> m in v LL (Inches)THICKNESS (Inches) Ft. to Ft. (✓) �) <br /> 0 270 22 ✓ (Tl-PE/SIZE I <br /> 1 ---- _ _ <br /> 2701 330 --,Q330 GRAVE.L <br /> t <br /> t <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 /> _. <br /> Well Construction Diagram NAME MASELLIS DRILLING INC. _-- <br /> _._. Geophysical Log(s) (PERSON,FIRM,0 ORPORATION) (TYPED OR PRINTED) <br /> -- Soil/Water Chemical Analysis 119 Allaws ,_. __ __ _ Modesto __.._CA 95357 <br /> ..- Other ADDRESS . CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT E)OSTS. Signed - -- -- ja ak K' - - 05/16/07 568622 -._- <br /> WELL DRILLE UTHORIZED REPRESENTATIVE DATE SIGNED C-67 LICENSE NUMBER <br /> DWR 188 REV 11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />