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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> Refer to Instruction Pamphlet STATE WELLNOJ STATION NO. <br /> Page Owner's Well No. 95320 No.e0283242 F-71 01 L I I LiIJ <br /> Date Work Began 8/13/2015 , E:nded9/17/2015 LATITUDE LONGITUDE <br /> Local Permit Agency Envimn-171+'1 laoalth __ 1 -I -j I I�I I I I I ! 11 <br /> Permit No. 72837 Permit Date 8/4/2015 <br /> GEOLOGIC LOG WELLOWNER <br /> �/ <br /> L.VERTICAL __ HORIZONTAL —ANGLE —(SPECIFY) Name DePalma Farms _ <br /> ORIENTATION(—) � <br /> DRILLING Mailin Address 18M3 E. 20 _ <br /> DEPTH FROM METHOD ROTARY Flulo ML-d— Escabn — , - CA 95320 <br /> SMFACE DESCRIPTION -- - - --- - <br /> FL b FL Describe material, grain, size, color, etc. CIT' STATE ZIP <br /> 0 3-T <br /> o SOiIH;1211 <br /> WELL LOCATIO <br /> P Address 22457 E Hwy(12U <br /> 3, 5 Hard Pan City Escalon CA 95320- <br /> 5 7 Sand — County San Joaquin_. <br /> - 7: 26 Cln - ---- — APN Book Page_ Parcel -- -- <br /> _26 63 Sand _ _ P Range a Section <br /> g <br /> 63 75 Clay _._ Latitude I <br /> 75 80 SandDEG. MIN. SEC. DEG MIN. SEC <br /> LOCATION SKETCH ACTIVITY (�) <br /> 80 88 Clay _ --- NORTH ✓ NEW WELL <br /> 88 92 .Sand MODIFICATION/REPAIR <br /> 92 --113 Clay ___ _ _ open <br /> 113; 130 Sand other Ispecafr <br /> 130 148,Clay DESTROY (Describe <br /> 148 150'SandProcedures and Matenals <br /> Under'GEOLOGIC LOG" <br /> 150 156 Clay _ _ PLANNED USES( ) <br /> 156. 166,Sand WATER SUPPLY <br /> - - -- - - - ---H <br /> 166-7 247'Clay __..._._. Domestic Public <br /> --i( Irrigation Industrial <br /> 247: -- 251 Gravel - - -- --- <br /> MONITORING— <br /> 251; 312 Clay TEST WELL— <br /> 312; 337 Sand and Gravel THaolc PROTECTION- <br /> 337; 360;Clay - - - HEAT EXCHANGE- <br /> -- - - <br /> DIRECTPUSH <br /> --. --- -- ---- - -- INJECTION — <br /> _ VAPOR EXTRACTION ._ <br /> SPARGING _ <br /> _ SOUTH REMEDIATION.__ <br /> ntranwt or dbxrfbe Dislancr f W,11f—Romb H-Afingr, <br /> Famm Rivaetc. and attach a map. Use additional papa if OTHER(SPECIFY) <br /> s. - <br /> -. PLEASE RE ACCURATE & COMPLETE- <br /> WATER LEVEL At VIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER - ---- (Ft.)BELOW SURFACE <br /> DEPTH OF STATtp� 8/17/2015 <br /> ---� -- WATER LEVEL VD (FL)8 DATE MEASURED - <br /> -- ----- ESTIMATED YIELD ' (GPM)8 TEST TYPE <br /> TOTAL DE FM OF BORING 360 (Feet) TEST LENGTH (Hrs-) TOTAL DRAWDOWN-- (Ft.) <br /> TOTAL DFPTFI OF COMPLETED WELL 340 (Feet) Mav not be representative o a well's fon -term yiel& <br /> DEPTH BORE- <br /> HOLE <br /> ORE- CASING(S) ANNULAR MATERIAL <br /> FROM SURFACE HOLE TYPE � FROM SURFACE _ <br /> DIA, Y UJI a MATERIAL I INTERNAL GAUGE SLOT SIS - -_ - -- -- CE- BEN-I FILTER PACK <br /> Ft. to FL (I ) Z GRADE DktUtas) OR <br /> (fthaa) FL to FL WALL IF ANY MENr TON FILL (TYPE/SIZE) <br /> --0: 300 18 _Q...;._--- — <br /> 300: 340 <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> Geologic Log 1.the wdarsigned,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 C WORATION) DOR PRI ) <br /> Soil/Water Chemical Analysis 119 AIbers Rd-- Od�sS4- Com—_95357_ <br /> Other __. .__ ADDRESS CIT' STATE ZIP <br /> c-TACH ADDITIONAL WfORMA77ON.IF ITOGSTS- S'gr _ e -.-. . AT-E SI 1 5 668622 _ <br /> WELL DRILLERJA l D E TATI DATE SIGNED C-57 LICENSE NUMBERII <br /> I)k%R IgE R.EV,11-97 IF ADDITIONAL SPACE IS NEEDED.USE NEXT CONSUCUTIVFI'�Y NUMBERED FORM <br />