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State of California Well Completion Report Form DWR 188 Auto -Completed 12/14/2020 WCR2020-014514 Owner's Well Number N/A Date Work Began 09/29/2020 Date Work Ended 10/02/2020 Local Permit Agency San Joaquin County Environmental Heafth Department Secondary Permit Agency Permit Number WP0041274 Permit Date 09/28/2020 Well Owner (must remain confidential pursuant to Water Code 13752) Former Use Name XXXXXXXXXXXXXXXXXXXX Activity Destroy Mailing Address XXXXXXXXXXXXXXXXXXXX Depth to Static Farmer Use Other XXXXXXXXXXXXXXXXXXXX City XXXXXXXXXXXXXXXXXXXX State XX Zip XXXXX Test Length (Hours) Total Drawdown (feet) Well Location Address 920 Frewert RD APN City Lathrop Zip 95330 County San Joaquin Township Latitude 37 50 47.2055 N Longitude -121 18 27.6624 W Range Section Deg. Min. Sec. Deg. Min. Sec. Baseline Meridian Dec. Lat. 37.846446 Dec. Long. -121.307684 Ground Surface Elevation Vertical Datum Horizontal Datum WGS84 Elevation Accuracy Location Accuracy Location Determination Method Elevation Determination Method Borehole Information Water Level and Yield of Completed Well Orientation Vertical Specify Depth to first water (Feet below surface) Depth to Static Drilling Method Drilling Fluid Water Level 17 (Feet) Date Measured 09/29/2020 Estimated Yield' (GPM) Test Type Total Depth of Boring Feet Test Length (Hours) Total Drawdown (feet) Total Depth of Completed Well 100 Feet `May not be representative of a well's long term yield. Destruction Details: No documentation or construction details existed for this well. It was determined to have a diameter of 18 inches. The well was observed to be backfilled to approximately 3 feet below ground surface (ft bgs). Per requirements of San Joaquin Environmental Health, the well fill material was cleared to the bottom of the well via drilling, and then the well was perforated via blasting and grouted. Since the well construction and depth of well was unknown, the bottom of the well was scheduled to be determined by an observed change in lithology from the fill material to native material. Relatively homogeneous fine gravel with silt was observed as the fill material from the top of the fill to approximately 100 ft bgs. At 100 ft bgs, the drill rig began to chatter, and a loss of drilling fluid circulation occurred. This behavior continued to the terminal depth of 136 ft bgs. Due to the loss of fluid circulation, no cuttings were returned from 100 to 136 ft bgs; however, based on the change in drill rig behavior and the loss of circulation, it was determined that a permeable native formation had been reached, and thus that the bottom of the well was at approximately 100 ft bgs. The field data were discussed with San Joaquin Environmental Health and permission to proceed with grouting was received. The well was then perforated via blasting from 20 ft bgs to the bottom of the well and the well was grouted from bottom up, in one continuous motion, with a tremie pipe using 11 sacks sand cement per 7 gallons water as the neat cement grout. A San Joaquin Environmental Health inspector was present to observe the blasting and grouting. The grouting was completed with a mushroom cap to 5 ft bgs and the remaining open space was backfilled with native soil from 5 It bgs to ground surface. Other Observations: Form DWR 188 rev. 12/19/2017 Page 1 of Z