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QUADRUPLICATE STATE OF CALIFORNIA DWR USE ONLY — DO NOT FILL IN <br /> For Local Requirements WELL COMPLETION REPORT rI l l l i l l l l <br /> Page I of I Refer to hatniction Prmrphlet STATE WELLNOJSTATION NO. <br /> Owner's Well No. 95366 ND.0937023 11-111111 111 1 E <br /> Date Work Began 8/8/2006 Endel:141 2006 LATITUDE LONGITUDE <br /> Local Permit Agency Fnvirenmental Health <br /> Permit No. 47692 Permit Date 8/4/2006 1 APNITRSIOTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION VERTICAL _HORIZONTAL ___ ANGLE —(SPECIFY) Name Fredriks Nursery <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID Mud Mailing Address 23223 S.Austin Rd <br /> SURFACE DESCRIPTION Ripon- CA 9.5366 <br /> Ft. to Ft. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 3 Soil TELLOCATio <br /> 3: 7 Sand Address 23245 S.Austin <br /> 7 28 Clay City Ripon CA <br /> -- - CountySan Joaquin <br /> 28 i 33;Sand — APN Book Page Parcel_- <br /> 33 i 73:Clay Township Range Section <br /> 73: 77 Sand Latitude <br /> 77: 105:Clay DEG. MIN. SEC. DEG. MIN. SEC, <br /> 105 110 Sand — LOCATION SKETCH ACTIVITY (✓) <br /> 110 117 Clay NORTH ✓ NEW WELL <br /> 117 121 Sand MODIFICATIONIREPAIR <br /> —Deepen <br /> 121: 160:Clay --Other(Specify) <br /> 160: 165;Sand <br /> — DESTROY(Descrbe <br /> 165: 177 Clay Pro rdures an GICILrials <br /> OG <br /> 177; 190,Sand PLANNED USES(.1) <br /> 190: 230:,Clay WATER SUPPLY <br /> 230: 235:Blue Clay Domestic— Public <br /> inIIndust"Irrigation — Indust" <br /> MONITORING— <br /> TEST WELL— Cr <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH <br /> INJECTION—_ <br /> VAPOR EXTRACTION— <br /> SPARGING <br /> SOUTH REMEDIATION— ` <br /> tlhusrrme w Describe Disrrnrce of Well from Rori&, Nuildng.% <br /> Fences,Riven,etc. and attach a map. Use additional paper if OTHER(SPECIFY)—. <br /> necessary. PLEASE BE ACCURATE & COMPLETE. <br /> WATER LEVEL&YIELD OF COMPLETED WELL <br /> DEPTH TO FIRST WATER -- (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STAT C <br /> WATER LEVEL 4 (Ft.)&DATE MEASURED._8/9/2006 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE _ <br /> TOTAL DEPTH OF BORING 235 (Feet) TEST LENGTH_ —(Hrs.) TOTAL DRAWDOWN___- _ (FL) <br /> TOTAL DEPTH OF COMPLETED WELL203 (Feet) AW not be representative ofa well's lon -teen yield. <br /> DEPTH BORE- CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE HOLE yjE FROM SURFACE p <br /> — DIA. a a MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) w pH a GRADE DIAMETER OR WALL IF ANY MENT TON FILL FILTER PACK <br /> Ft. to FL to y c�� 4 (Inches) THICKNESS (Indies) Ft. to Ft. ✓ ✓) U (1YPE/SIZE) <br /> 0 163 14 <br /> 163 203 EL <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 CO ORATION)(TYPED OR PRINTED) <br /> Soil/Mler Chemical Analysis .119 Albe[a Rd. Modesto CA 95357 <br /> Other ADDRESS s I CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF ITEXISTS. Signed Q� DB/22/06 668622 _ <br /> WELL DRILLER/ D REP ESENTATIVE DATE SIGNED CS7 LICENSE NUMBER <br /> DIKR 189 REV.I 1-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />