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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT L. <br /> Page 1 of 1 Refer to Instruction Pamphlet STATE WELL N0./STATION NO. <br /> Owner's Well No. 95336 No.e0372178 <br /> Date Work Began 3/15/2019 Ended3/18/2019 LATITUDE LONGITUDE <br /> Local Permit Agency Fnvirnnmental Health _ I I I I I I I I I I I I I <br /> Permit No. wp0038583 Permit Date 3/4/2019 APN/rRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name John Hale <br /> DRILLING ROTARY DEPTH FROM METHOD FLUID Mud Mailing Address 10411 Small Rd <br /> SURFACEDESCRIPTION Manteca CA 95336 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 4 Top Soil Address 1842 E Palm Tree Ln LOCATION <br /> 4 27 Sand Cit,Manteca CA 95336 <br /> 27 39 Clay County San Joaquin <br /> 39 72 Sand APN Book Page Parcel <br /> 72 123 Clay Township Range Section <br /> 123 160 Sand Latitude I I 1 <br /> 160 164 Clay DEG. MIN. SEC. DEG. MIN. SEC. <br /> 164 185 Sand LOCATION SKETCH ACTIVITY (✓) <br /> NORTH -/ NEW WELL <br /> 185 186 Clay <br /> 186 189 Sand MODIFICATIONIREPAIR <br /> —Deepen <br /> 189 190 Clay —Other(Specify) <br /> 190 215 Sand <br /> 215 220 Shale —PE�ures(Describenrials <br /> Under"GEOLOGIC LOG' <br /> 220 237 Sand PLANNED USES(.) <br /> 237 240 Clay WATER SUPPLY <br /> rn Domestic— Public <br /> LL Q IrrigationIndustrial <br /> 5 ul 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. <br /> SPECIFY)_necessary.PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> DEPTH OF STATjC <br /> WATER LEVEL (Ft.)&DATE MEASURED 3/18/2019 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 240 (Feet) TEST LENGTH <br /> (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 240 (Feet) May not be representative of a well's lon -term yield. <br /> DEPTH <br /> BORE- DEPTH CASING(S) ANNULAR MATERIAL <br /> FROM SURFACE HOLE OTYPE ✓) FROM SURFACE TYPE <br /> DIA. w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. to Ft. (Inches) U p a GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FI(TYPE/SIZE)K <br /> LL (Inches) THICKNESS (Inches) Ft. to Ft. ✓ (✓) U�) <br /> 0 220 11 PLASTIC 6 20 0 1100 <br /> 220 240 .045 100 240 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 CORPORATION). (TYPED OR PRINTED) <br /> — Soil/Water Chemical Analysis 119 Albers Rd Modesto CA 95357 <br /> — Other ADDRESS - CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 03/25/19 668622 <br /> 11 WELL DRILLER/AUTHORIZED REPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />