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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — 00 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. 95320 No.e0355248 <br /> Date Work Began 10/17/201.7 Endedl0/18/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health I I I I I I I I I _L I 1 <br /> Permit No. wp0037382 Permit Date 10/6/2017 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -V VERTICAL HORIZONTAL —ANGLE —(SPECIFY) Name JW West LLC <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 30962 Combs Rd <br /> SURFACEDESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 5 Top SoilAddress 28950 E. LemonAveL LOCATION <br /> 5 13 Clay City Escalon CA 95320 <br /> 13 18 Sand <br /> 18 28 Clay CountySan Joaquin <br /> APN Book Page Parcel <br /> 28 34 Sand Township Range Section _ <br /> 34 38 Clay Latitude 1 1 1 <br /> 38 43 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 43 501 Clay LOCATION SKETCH ACTIVITY (✓) <br /> 50 56 Sand <br /> NORTH �L NEW WELL <br /> 56 86 ClayMODIFICATIONIREPAIR <br /> —Deepen <br /> 86 100 Gravel —Other(Specify) <br /> 100 108 Clay <br /> — DESTROY(Describe <br /> 108 115 Sand Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> 115 142 Clay PLANNED USES(�) <br /> 142 149 Sand and Gravel /\�� Q <br /> WATER SUPPLY <br /> 149 168 Clay U) Q 1 r <br /> v I � � Domestic— Public <br /> 168 179 Gravel e, Irrigation _ Industrial <br /> 179 253 Clay <br /> �� ' MONITORING— <br /> TEST WELL_ <br /> 253 254 Sand ATHODIC PROTECTION- <br /> 254 260 Clay HEAT EXCHANGE- <br /> 260 263 Sand DIRECT PUSH_ <br /> 263 281 Clay INJECTION— <br /> 281 282 Sand <br /> VAPOR EXTRACTION— <br /> SPARGING_ <br /> 282 308 j Clay SOUTH REMEDIATION— <br /> 308 314 Black Sand Illustrate or Describe Distanceof Re11 from Roads, Buildings, <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)_ <br /> 314 340 Clay 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 C <br /> WATER LEVEL 00 (Ft.)&DATE MEASURED 10/18/2017 <br /> TOTAL DEPTH OF BORING 340 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH (His.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 320 (Feet) May not be representative of a well's long-term yield <br /> DEPTH CASING <br /> (SDEPTH <br /> ) ANNULAR MATERIAL <br /> FROM SURFACE HARE TYPE FROM SURFACE TYPE <br /> DI) • Y w o- MATERIAL! INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) Z O a GRADE DIAMETER OR WALL IF ANY MENT TONI FILL FILTER PACK <br /> Ft. to Ft. m v LL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) �) (TYPE/SIZE) <br /> 0 300 105/8 <br /> 300 320 .045 200 3M GRAVEL <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 CORPORA N) (TYPED R PRIM�ED) <br /> — Soil/Water Chemical Analysis 119AIbe Rd .,*A A 111011g, Mndesto CA 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 10/23/17 668622 <br /> WELL DRIL HCTIRIM PRESqh1TA-rIVEIfDATE SIGNED C-57 LICENSE NUMBER <br /> DWR 189 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXttONSECUTIVELY NUMBERED FORM <br />