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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. 95320_ NO'e0372206 I I I 1=1 ❑ <br /> Date Work Began 5/9/2019 Ended5/10/2019 LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Health _ I I I I I I I I I I I I I h <br /> Permit No. wp0039530 Permit Date 4/22/2019 APN/rRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name Frank Hagan <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 27946 OWnes Rd <br /> SURFACEDESCRIPTION Escalon CA 95320 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 4 Top Soil Address 27946 Ownes RYELL LOCATION <br /> 4 8 Hard Pan City Escalon CA 95320 <br /> 8 15 Sand County San Joaquin <br /> 15 211 Clay APN Book Page Parcel <br /> 21 28 Sand Township Range Section <br /> 28 42 Clay Latitude I I I <br /> 42 48 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 48 58 Clay LOCATION SKETCH ACTMTY (V) <br /> 58 105 Sand NORTH V NEW WELL <br /> FICATIONIREPAIR <br /> MODI <br /> 105 155 Clay —Deepen <br /> 155 168 Sand and Gravel —Other(Specify) <br /> 168 233 Clay <br /> — <br /> DESTROY (Describe <br /> 233 238 Sand and Gravel Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> 238 258 Clay O <br /> 258 260 Sand PLANNED USES <br /> WATER SUPPLY <br /> 260 262 Clay Domestic— Public <br /> 262 263 Sand — Irrigation _ Industrial <br /> 263 289 Clay MONITORING— <br /> TEST WELL— <br /> 289 290 Sand ATHODIC PROTECTION- <br /> 290 304 Shale HEAT EXCHANGE- <br /> 304 306 Sand DIRECT PUSH_ <br /> 306 348 Clay INJECTION— <br /> VAPOR EXTRACTION— <br /> 348 353 Shale SPARGING_ <br /> 353 357 Sand SOUTH REMEDIATION— <br /> Illustrate or Dexribe Distance of Well from Roads, Buildings, <br /> 357 365 Shale 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 STATC <br /> WATER LEVEL (Ft.)&DATE MEASURED 5/10/2019 <br /> TOTAL DEPTH OF BORING 365 ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 315 (Feet) I May not be representative o a well's long-term yield <br /> DEPTH BORE- 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 /> Ft. nches) Z W a GRADE DIAMETER OR WALL IF ANY FILTER PACK <br /> Inches THICKNESS (Inches) Ft. to Ft MENT TON) FILL <br /> to Ft m <br /> (Inches) ) (TYPE/SIZE) <br /> LL <br /> 0 275 12 <br /> 275 315 .045 204 315 G EL <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> — Geologic Log I,the undersigned,certify that this report is complete and accurate to the beat of my knowledge and belief. <br /> — Well Construction Diagram NAME MASELLIS DRILLING INC <br /> — Geophysical Log(s) (PERSON,Foltil,,OR CORPTION (TYPED OR PRINTED) <br /> — SoiVWater Chemical Analysis 1 A 95357 <br /> — Other ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 06/11/19 668622 <br /> WELL D AUTHO REP ENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CO CUTNELY NUMBERED FORM <br />