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QUADRUPLICATE STATE OF CALIFORMADWR USE ONLY - DO NOT FILL IN <br /> For Local Requirements WELL COiWLETION MORT = <br /> Page I of I Refer to hrslrucaon Panollel STATE WELL NOJ STATION NO. <br /> Owner's Well No. 95219 No.0927071T I I f <br /> Date Work Began 3/15/2004 Ended3/30/2004 LATITUDE JJ LONGITUDE <br /> Local Permit Agency Envirarimantal Health I I <br /> Permit No_ 36802 Permit Date 2/2/2004 APNITRSIOTHER I <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL_HORIZONTAL —ANGLE —(SPECIFY) Name Lisa Schletewitz <br /> DRILLING <br /> DEPTH FROM METHOo '3 -''RY FLUID Mud Mailing Address 5554 Vintage Circle _ <br /> SURFACE DESCRIPTION Stockton CA 95219 <br /> Ft. to Ft Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3.Top Soil Address 2782 Arata Rd. WELL LOCATION <br /> 3 9 j Clay Stockton CA <br /> _ 9 12;Sand Ctry— - -- <br /> 12 70.Clay County San Joaquin -_ <br /> 70: 81 •Sand&Gravel APN Book- Page_ Parcel— <br /> 81 145.Cfay <br /> ---- Township Range —Section -- <br /> Latitude— . I 145 147'Sand DEG. MIN. SEC. -DEG. MIN. S_EC <br /> 147. 162 Clay ` —- LOCATION SKETCH ACTIVITY &) <br /> 162 164:Sand NORTH-_ -x/. NEW WELL <br /> 164: 173-Clay MODIFICATIOWREPAIR <br /> —Deepen <br /> 173. 176:Sand —other(Specify) <br /> 176: 190.Clay <br /> 190; 195!Sand — DESTROY(Describe <br /> Procedures and Materials <br /> 195: 225:Clay Under"GEOLOGIC LOG" <br /> 225: 227 i Sand PLANNED TYSES(/-) <br /> WATER SUPPLY <br /> 227 282:Clay Domestic— Public <br /> 283 289:Sand — Irrigation — Industrial <br /> 289• 293 Olay MONITORING-- <br /> -'-'-" -- TEST WELL <br /> ATHODIG PROTECTION— <br /> _ HEAT EXCHANGE- <br /> DIRECT PUSH <br /> -- �- - - -- INJECTION <br /> VAPOR EXTRACTION- <br /> -- SPARGING - <br /> - SOUTH REMEDIATION <br /> -- 111-tram or Dearribe Dirrmxc of WcOfrom Rw,b,,,Bairn." <br /> Fences,Rivers,etc. and attach a map.Use additional paper if OTHER(SPECIFY)- <br /> -- necefsary,PLEASE BE ACCURATE 3 COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (FL)BELOW SURFACE 1 <br /> DEPTH OF STATIQ <br /> - -- - "--'— ---"'--"' —'-- WATER LEVEL 68 (Ft.)&DATE MEASURED 3/19/2004 <br /> TOTAL DEPTH OF BORING 293 _ ESTIMATED YIELD . _ (GPM)& TEST TYPE _ _ <br /> (Feet) TEST LENGTH (Hrs.)TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WFLL236 (Peet) May not be re resentative ofa well's lon -teraf vielct. <br /> i <br /> DEPTHBORE CASING(S) DEPTH <br /> ANNULAR MATEWAL <br /> FROM SURFACE HOLE TYPE <br /> �) I FROM SURFACE TYPE <br /> -- DIA. Y w I QI MATERIAL INTERNAL, GAUGE SLOT SIZEBEN- <br /> 0 <br /> I <br /> (Inches) z w I0'' GRADE +DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> -Ft. to Ft. m y iv❑ LL' (Inches) THICKNESS (inches) Ft. to Ft. ✓) (✓) u (TYPEISIZE) <br /> 0; 216 12 ✓ 1 0 <br /> 1 - -- <br /> 216; 236 ✓ _ _—_ _ -,g4 23 GRAVEL <br /> ATTAC10TENTS (✓_) CERTIFICATION STATENTENT <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,O ORPORATION)(TYPED OR PRINTED) <br /> Soil/Water Chemical Analysis 119 Albers Rd. __ Modesto CA 95357_ <br /> Other ADDRESS r CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF fT IXISTS. Signed Le r �!f.,,(�i{ _—— 03/30/04 68622 <br /> WELL DRILLE ORIZED REPRESENTATIVE DATE SIGNED 657 LICENSE NUMBER, <br /> DWR 198 REV.11-07 1F ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />