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QUADRUPLICATE STATE OF CALIFORNIADWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Page I of 1 Refer to Instruction Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95366 No.e0348024 <br /> Date Work Began 7/12/2017 Ended7/13/2017 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health <br /> Permit No. 77656 Permit Date 6/6/2017 APN/TRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) -0"-VERTICAL —HORIZONTAL ANGLE —(SPECIFY) Name Richard Dolezal <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 20992 S. Olive Ave <br /> DESCRIPTION Ripon CA 95366 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Top Soil21510 S Olive Ave <br /> LOCATIO <br /> Address <br /> 3 15 Sand City Ripon CA 95366 <br /> 15 451 Clay - <br /> CountySan Joaquin <br /> 45 87 Sand <br /> APN Book Page Parcel <br /> 87 121 Clay Township Range Section <br /> 121 133 Sand Latitude I 1 I <br /> 133 173 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 173 176 Sand LOCATION SKETCH ACTIVITY (✓) <br /> NORTH -0' NEW WELL <br /> 176 180 Shale <br /> 180 209 Cela MODIFICATION/REPAIR <br /> Clay —Deepen <br /> 209 212 Sand —other(Specify) <br /> 212 221 Clay <br /> 221 224 Sand — DESTROY <br /> (Describe <br /> Dnd Materials <br /> Under"GEOLOGIC LOG' <br /> 224 226 Clay PLANNED USES() <br /> 226 237 Sand WATER SUPPLY <br /> 237 2401 Clay Domestic— Public <br /> LQ Irrigation _ Industrial <br /> lL 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 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 1 <br /> DEPTH OF STAT C <br /> WATER LEVEL l36 (Ft.)&DATE MEASURED 7/13/2017 <br /> TOTAL DEPTH OF BORING 240 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 240 (Feet) May not be representative of a well's long-term yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE ✓) FROM SURFACE PE <br /> DIA.( Y w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Inches) Z w o a GRADE DIAMETER OR WALL IF ANY FILTER PACK <br /> MENT TONIT FILL <br /> Ft. to Ft, m U v LL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ 60 L) (TYPE/SIZE) <br /> 0 220 11 PLASTIC 6 90n 0 100 <br /> 220 240 .045 100 240 G EL <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 CORPORATI (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 Alb IS R s Modesto CA 95357 <br /> — Other ADDRESS ' �,'.a ', CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT IXISTS. Signed 07/24/17 668622 <br /> WELL DRILLER/AUTHOR ZE RESE TI DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.I1-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT NSECI d1VELY NUMBERED FORM <br />