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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT i I I j l i 11= <br /> Page I of I Refer to Instruction Pamphlet (� STATE WELL NOO.1 STATION NO. <br /> Owner's Well No. 95366 _ No.e0367535 I_I I I I—I ][][- [—L_t.-,- � I I 0 <br /> Date Work Began..611912018 Ended... � LATITUDE LONGITUDE <br /> Local Permit Agency Environmental Resources _ _____. L l l—L1_L....,.L_L_1__L—l._ i I <br /> Permit No. wP_0_Qa 20— _—Permit nate___6!1312018 APN(MSIOTHER <br /> �.—_.___..._..._.—_.__ <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) VERTICAL -.__._.HORIZONTAL —.-ANGLE —.._-(SPECIFY) Name Brett McIntosh <br /> DRILLING ROTARY <br /> DEPTH OM -�METHOD FLUID Mud Mailing Address 1333 W.4th St- <br /> FR <br /> —._.Ssl>facE--j DESCRIPTION Ripon CA 95366 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> —....._._. .._.__ __— <br /> WE LOCATION <br /> 0 2 Top Soil Address 23811 S.Jacktone hb <br /> 2 20 Cla City Ripon CA 95366 <br /> 20 23 Sand <br /> 23 53 Clay Cout,riSan Joaquin <br /> APN Book Page Parcel <br /> 53 58 Sand Township Range Section <br /> 58 981 Clay Latitude <br /> 98 108 1 Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 108 113 Clay LOCATION SKETCH ACTIVITY f✓) <br /> NORTH .f NEW WELL <br /> 113 118 Sand MODIFICATIONIREPAIR <br /> 118 135 Clay —Deape <br /> 135 137 Sand —other(Specify) <br /> 137 168 Clay <br /> —DESTROY(Deacnbe <br /> 168 178 Sand Procedures and Materials <br /> Under"GEOLOGIC LOG" <br /> 178 218 Clay PLANNED USES(.,) <br /> 218 222 Sand WATER SUPPLY <br /> 222 255 Clay n y Domestic -- PuWic <br /> 255 257 Sand _-- Irrigation Industrial <br /> 257 262 Clay MONITORING— <br /> TEST WELL- <br /> 262 264 Sand ATHODIC PROTECTION- <br /> 264 303 Clay HEAT EXCHANGE- <br /> 303 305 Sand DIRECT PUSH- <br /> 305 325 Clay INJECTION— <br /> VAPOR EXTRACTION— <br /> SPARGING— <br /> SOUTH REMEDIATION— <br /> lllastrase or Descnhc Distance of Wellfrom Roads, Buildings. <br /> Fa wes,Rivers,etc. and attach a snap. Use additional paper if OTHER(SPECIFY)— <br /> necessary. PLEASE RE ACCURA77E & COMPLETE. <br /> WATER LEVEL.&YIELD OF COMPLETED WELL. <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE <br /> DEPTH OF STAT C 6/20/2018 <br /> WATER LEVEL —(Ft.)&DATE MEASURED <br /> ESTIMATED YIELD (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 325 —(Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 312 ......._,_(Feet) Afay not be representative o a well's loo -term yield <br /> DEPTHCASING_ (S) DEPTH ANNULAR MATERIAL <br /> BORE- --- —.._—__._....— <br /> FROM SURFACE HOLE TYPE FROM SURFACE p <br /> DIA. Y w a MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (inches) 2 W O GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft. to Ft. m N v LL (inches) THICKNESS (Inches) Ft. to Ft. j J EN (TYPEISIZE) <br /> 0' 292' 12 <br /> 292 3121 045 205 31 GRAVEL <br /> I <br /> 1 <br /> ATTACHMENTS CERTIFICATION STATEMENT <br /> — GeOWQC Log 1,the undersigned,ce"that this report is complete and accurate to the best of my know ledge and belle}. <br /> — wan Construction Diagram lVAME.._MASELLIS_DRILLING INC ,---.-___,____—,_-_.-._.-- <br /> - Geophysical Logi(s) (PERSON,FI R CORPORAft) (TYPED P IN-MD) <br /> — So(tater Chemical Arasysia j 19 Albem Rd CA 95357 <br /> — Other _ ADDRESS CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. * amymww06/21/18 668622 <br /> Ii WELL DRILLER/AUTHOR PRES ATIVE P DATE SIGNED C-57 LICENSE NUMBER <br /> DNR 188 REV.1 t-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />