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OIGINAL STATE OF CALIFORNIA DWR USE O L — DQ NOT FILL IN <br /> File with DWR WELL COMPLETION REPORT <br /> Page`Nf I Refer to /nsnruction Pamphlet STATE WELL NO./STATION NO. <br /> dwner's Well No. 95215 No.808968 <br /> Date Work Began 12/3/01 Ended 12/4/01 LATITUDE LONGITUDE <br /> Local Permit Agency Public Health Services <br /> Permit No. 27768 Permit Date 10/15/01 APNfrRS/OTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION VERTICAL _HORIZONTAL — ANGLE —(SPECIFY) <br /> DRILLING <br /> DEPTH FROM METHOD ROTARY FLUID Mud <br /> SURFACE DESCRIPTION <br /> FI. to Fl. Describe material, grain, size, color, etc. _ <br /> 0, 4:Soil Address 7514 S. Elm St-WELL LOCATION <br /> 4' 25'Clay City French Camp CA <br /> 25' 30'Sand CountySa�n Joauin <br /> 30' 73'Clay <br /> 73, 84�Silt APN Book`� _Page_12,0 Parcel <br /> Township Range Section <br /> 84 85 Clay Latitude <br /> 85:____9_0_T,Sand DEG. MIN. SEC. DEG. MIN. SEC. <br /> 90; 120:Clay LOCATION SKETCH ACTIVITY (✓) <br /> 120 i 125 Sand -- NORTH _Y' NEW WELL <br /> MODIFICATION/REPAIR <br /> 125 144;Clay Deepen <br /> 1441 150'Sand Other(Specify) <br /> , <br /> 150, 165,Clay - — <br /> DESTROY(Describe <br /> 165 i 170 i Sand Procedures and Materials <br /> Under"GEOLOGIC LOG' <br /> 170, 174,Blue Clay PLANNED USES(.✓_) <br /> 174; 176,Sand WATER SUPPLY <br /> 176; 205;Blue Clayr~n — Domestic�C Public <br /> W Irrigation Industrial <br /> 205' 231 'Sand&Gravel 3 � <br /> 231 253 Blue Clay MONITORING— <br /> TEST ELL <br /> 253: 259:Coarse Sand ATHODIC PROTECTION <br /> / 259, 300 Blue Clay HEATEXCHANGE— <br /> DIRECT PUSH_ <br /> INJECTION <br /> VAPOR EXTRACTION _ <br /> i SPARGING <br /> SOUTH – <br /> REMEDIATION <br /> Illustrate or Dercrihr l)igmtee of Wellft—Itrrrulr. Hui/Jugs. <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 <br /> DEPTH OF STATJ <br /> WATER LEVEL J5 -(FL)&DATE MEASURED 12/7/01 <br /> ESTIMATED YIELD ' (GPM)& TEST TYPE <br /> TOTAL DEPTH OF BORING 300 (Feet) TEST LENGTH (Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL265 (Feet) I May not be representative o a Ivell's long-term yield. <br /> DEPTH CASING(S) DEPTH ANNULAR MATERIAL <br /> FROM SURFACE BORE TYPE ✓) FROM SURFACE TYPE <br /> HOLE — <br /> DIA. y Z a MATERIAL I INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> (Inches) 5 Lu p J GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> Ft. to Ft. o uo LL (Inches) THICKNESS (Inches) FI. to FI. ✓) (—) �) (TYPE/SIZE) <br /> .0 <br /> 0: <br /> ✓ ✓ <br /> 0, 225 14 j _PLASTIC 8 200 0 180 ✓ <br /> 225; 265 .045 180 265 GRAVEL <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,0 ORPORATION) (TYPED OR PRINTED) <br /> Soivwater Chemical Analysis 119 Albers Rd. Modesto CA 95357 <br /> Other ADDRESS s CITY STATE ZIP <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed _ 12/12/01 668622 <br /> WELL DRILL ORIZED EPRESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 169 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />