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ORIGINAL STATE OF CALIFORNIA QWIR USE ONL — RO NOT FILL IN <br /> File with DWR WELL COMPLETION REPORT <br /> Page I of I Refer to Instruction l amphlet STATE WELL NO/STATION NO <br /> .,Owner's Well No 95366 No 094760 <br /> ❑ <br /> Date Work Began 9/13/2011 Ended9/22/2011 LATITUDE ❑ LONGITUDE <br /> Local Permit Agency Envirnnmpntaal Hpalth I I I I I. I I I I _1 _1 <br /> Permit No 63382Permit Date <br /> 9/13/2011 APNITRS/OTHER <br /> GEOLOGIC LOG <br /> ORIENTATION VERTICAL _HORIZONTAL — ANGLE —(SPECIFY) <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD — FLUID Mud <br /> SURFACE I DESCRIPTION <br /> Ft to Ft I Describe material grain size color etc <br /> r <br /> 0 2 Top SOII Address <br /> 2 8 Sand Cit,Ripon CA 95366 <br /> 8 12 Clay County San J a uin <br /> 12 18 Sand APN Book Page PW Parcel <br /> 18 25 Clay �}—/� <br /> 25 38 Sand Latitudep7 7 ang5^ Section/ A <br /> 38 62 Clay DEG MIN SEC 7 DEG-( MIN SEC <br /> 62 70 Sand LOCATION SKETCH ACTIVITY (✓) <br /> 70 87 Clay NORTH _✓_ NEW WELL <br /> 87 91 Sand MODIFICATION/REPAIR <br /> —Deepen <br /> 91 126 Clay —Other(Specify) <br /> 126 138 Sand _ <br /> 138 210 Clay PErocedurres(e d Materials <br /> Under GEOLOGIC LOG <br /> 210 220 Sand PLANNED USES() <br /> 220 293 Clay WATER SUPPLY <br /> 293 294 Sand — Domestic Public <br /> W <br /> — litigation Industrial <br /> 294 303 Clay MONITORING— <br /> 303 304 Sand <br /> TEST WELL— <br /> 304 306 Clay ATHODIC PROTECTION- <br /> 306 308 Sand HEAT EXCHANGE- <br /> 308 340 Clay DIRECT PUSH- <br /> - — INJECTION <br /> VAPOR EXTRACTION — <br /> SPARGING_ <br /> SOUTH REMEDIATION— <br /> III aat D rib D to f W 11 from Road R Id g <br /> F ce W ers t and it h map Use add tonal p pe f OTHER(SPECIFY)— <br /> ns ry PLEASE BE ACCURATE & COMPLETE <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (FI)BELOW SURFACE <br /> DEPTH OF STATLCL 9/14/2011 <br /> WATER LEVEL bb 1 (Ft)&DATE MEASURED <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 340 (Feet) TEST LENGTH <br /> TOTAL DEPTH OF COMPLETED WELL 314 (His) TOTAL DRAWDOWN (Ft) <br /> (Feet) Ma not be representative o a wells loniz term yield <br /> DEPTH BORE CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE �) FROM SURFACE TYPE <br /> DIA x w a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE BEN <br /> (Inches) Z w 01. a GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft to Ft m v LL (Inches) THICKNESS (Inches) Ft to Ft ✓ ✓) �) (TYPE/SIZE) <br /> (� <br /> 0 294 12 ,/ LASTJ_ 20 0 2QQ ✓ <br /> 294 314 ✓ Q45_ 200 314 GRAVEL <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> — Geologic Log I the undersigned certify tht s report is complete and accurate to the best of my knowledge and belief <br /> — Well Construction Diagram NAME MASELLIS LING INC <br /> — Geophysical Log(s) (PERSON ORPORATION) (TYPED OR PRINTED) <br /> — SoiVWater Chemical Analysis 119 Albers Rd _/Modesto CA 96357 <br /> — Other ADDRESS f— CITY STATE ZIP <br /> 09/22/11 668622 <br /> ATTACH ADDITIONAL INFORMATION IF IT IXISTS WELL DRILLE 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 />