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QUADRUPLICATE STATE OF CALIFORNIA IDWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT <br /> El <br /> Page I of 1 Refcr to /Artrncrion Pamphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. 95366 No.774116 11 I I D I I E <br /> Date Work Began 11/7/00 Endedl l/10/00 LATITUDE- LONGITUDE <br /> Local Permit Agency Public Health Servoces <br /> Permit No. 24485 Permit Date 11/6/00 APmlKWOTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(V) _aL VERTICAL _HORIZONTAL —.._ ANGLE _(SPECIFY) Name Fredriks Nurse <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud _ Mailing Address 23223 S.Austin Rd. _ <br /> D= <br /> E DESCRIPTION Ripon CA 95366 <br /> FL to Ft. Describe material, grain, size, color, etc. CITY WE LOCATIO STA. ZIP <br /> 6 6 Soil, Address 23245 S.Austin Rd. <br /> 6 12:Sand _ __ City Ripon CA <br /> - 12' 401 Clay&Sand Streaks -_ CountySan Joaquin <br /> 40 <br /> 46,Sand APN Book_ Page pare) <br /> 46, 84,Clay Township_ Range Section <br /> 84 90 Sand Latitude <br /> 90 140,Clay DEG. MIN. SEC. DEG I MIN SEC. <br /> 140; 144,Sand -- -- -— LOCATION SKETCH ACTIVITY L) <br /> 144' 150'Clay NORTH — ✓ NEW WELL <br /> 150' 163,Coarse Sand MODIFICATIONIREPAIR <br /> Clay Deepen <br /> 163, 190,Clay Other(Specify) <br /> 190 196,Coarse Sand <br /> 196 235 ClayDESTROY(Describe Q <br /> Procedures and Materials N <br /> Under"GEOLOGIC LOG" U) <br /> PLANNED USES() <br /> WATER SUPPLY <br /> yDomestic_ Public <br /> Irrigation _ Industrial (� <br /> ul MONITORING— 1 <br /> TEST WELL-_ <br /> ATHODIC PROTECTION._ <br /> HEATEXCHANGE— .� <br /> DIRECT PUSH. fi <br /> INJECTION _ <br /> VAPOR EXTRACTION _ <br /> i SPARGING <br /> - SOUTH REMEDIATION_ <br /> /)raribe D1%1m oJWdrfvnr RaaA. BuilkfiiW, <br /> ` Fences,Rivers,etc. and anach a map. Use additional paper if OTHER(SPECIFY)_ \ <br /> -- -- eeceasary. PLEASE BE ACCURATE & COMPLETE. <br /> If WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STAT 1C <br /> ---- — WATER LEVEL 16 (FL)&DATE MEASURED 11/10/00 <br /> � ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 235 (Feet) TEST LENGTH <br /> (Hrs.)TOTAL DRAWDOWN _ (FL) <br /> TOTAL DEPTH OF COMPLETED WELL205 (Feet) May,not be representative o,f n it-ell's la:Q-term yield <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE- TYPE �) FROM SURFACE TYPE <br /> HOLE - <br /> -- DIA. ]C yZj g MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN <br /> (Inches) w ° GRADE DIAMETER OR WALL IF ANY MENT TONn FILL FILTER PACK <br /> Ft to FL m v LL (Inches) THICKNESS (Inches) Ft. to Ft (✓) �) (TYPE/SIZE) <br /> 0, 185 14 PLASTIC 8 160 160 . 0 . 108 <br /> 185; 205 108 ' 205 GRAVEL <br /> ------------------------ , <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 _. _ SignedADDRs — � �A����C cm STATE— ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS n� E _..-_ ATE SI� _ 6622 <br /> LL DRILLERlAUTH OOZE DATE SIGNED C-57 LICENSE NUMBER <br /> DNVR I8H RFV 11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />