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Owner's Copy WELL COMPLETION REPORT =1 7 <br /> Page 1 of I Refer to hrstniction Painphlet STATE WELL NO./STATION NO. <br /> Owner's Well No. ZUCKERMAN No.2021-009839 1] �_1 111 E�-I i I I I ] <br /> Date Work Began 6/25/2021 Fnded7/7/2021_ _ LATITUDE LONGITUDE <br /> Local Permit Agency SAN JOAQUIN CO FHC) _ EFT I I I I I I I I I—L11 1 <br /> Permit No.WPOO41974 Permit Date 4/26/2021 APN/TRSIOTHER <br /> GEOLOGIC LOG WELL OWNER <br /> ORIENTATION(✓) --I'—VERTICAL —HORIZONTAL —ANGLE —(SPECIFY) Name CANDYCE HOLLIDAY <br /> DRILLING ROTARY <br /> DEPTH FROM METHOD FLUID MUD Mailing Address 5951 TERRA BELLA LANE <br /> RFACE _ DESCRIPTION CAMARILLO CA 93012 <br /> Ft. to R. Describe material, grain, size, color, etc. CITY STATE ZIP <br /> 0 4 TOP SOIL _ — _ Address 4103 ZUCKEFdff*&OCATIO, <br /> 4 15 SAND City STOCKTON CA 95202 <br /> 15 24 BLUE CLAY County SAN JOAQUIN _ <br /> 24 30 BLACK CLAY APN Book 129 Page 080 Parcel 54 <br /> 30 40 SAND Township Range_ Section _ <br /> 40 60 COARSE BLUE SAND Latitude <br /> 60 80 BLUE CLAY_ _ DEG. MIN. SEC. DEG. MIN. <br /> SEC <br /> -- LOCATION SKETCH ACTIVITY (v) <br /> NORTH --I/— NEW WELL <br /> MODIFICATION/REPAIR <br /> —Deepen <br /> —Other(Specify) <br /> X — DESTROY (Describe <br /> Procedures and Materials <br /> I <br /> Under"GEOLOGIC LOG" <br /> PLANNED USES(,--) <br /> WATER SUPPLY <br /> —30� Domestic__ Public <br /> Q — Irrigation _ Industrial <br /> u.l MONITORING— <br /> TEST WELL_ <br /> ATHODIC PROTECTION— <br /> HEAT EXCHANGE— <br /> DIRECT PUSH— <br /> INJECTION— <br /> VAPOR EXTRACTION— <br /> SPARGING_ <br /> SOUTH REMEDIATION— <br /> Illustrate or Describe Distancv of Wel{front Hrmds, Rnildings, <br /> Fences,Rivers,etc. and attach a map. Use additional paper if OTHER(SPECIFY)— <br /> necessary. PLEASE. BE ACCURATE & COMPLETE. <br /> WATER LEVEL&VIELD OF COMPLETED WELL. <br /> DEPTH TO FIRST WATER (Ft.)BELOW SURFACE 1 <br /> DEPTH OF STAT C <br /> WATER LEVEL �0 (Ft.)&DATE MEASURED 7/7/2021 <br /> TOTAL DEPTH OF BORING 80 ESTIMATED YIELD (GPM)& TEST TYPE <br /> (Feet) TEST LENGTH—(Hrs.) TOTAL DRAWDOWN (Ft.) <br /> TOTAL DEPTH OF COMPLETED WELL 63 _(Feet) May not be representative o a well's long-term yield. <br /> DEPTH ; gORE- __"__ CASING(S) <br /> FROM SURFACE DEPTH ANNULAR MATERIAL. <br /> HOLE TYPE —> FROM SURFACE TYPE <br /> r --— -- <br /> _ <br /> DIA• z W a MATERIAL/ INTERNAL GAUGE SLOT SIZE CE- BEN- <br /> Ft. to Ft. (Inches) g w p J GRADE DIAMETER OR WALL IF ANY MENT TONIT FILL FILTER PACK <br /> m a (Inches) THICKNESS (Inches) Ft. to Ft. (✓) �) (TYPEISIZE) <br /> 0 43' 11" 22, ✓ <br /> 43 63 11" ✓ 1 .045. 22 63 i 8X16 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_CALWATER DRILLING CO.,INC. <br /> — Geophysical Log(s) (PERSON,FIRM,OR CORPORATION) (TYPED OR PRINTED) <br /> — SoiVWater Chemical Analysis 3 Kllf Rd. Turlock <br /> — Other ADDRESS CITY <br /> STATE 21P <br /> ATTACH ADDITIONAL INFORMATION,IF IT EXISTS. Signed 08/06/21 434218 <br /> WELL DRILLERIAUTHORIZ RE ESENTATIVE DATE SIGNED C-57 LICENSE NUMBER <br /> DWR 188 REV.11-97 IF ADDITIONAL SPACE IS NEEDED,USE N T NSECUTIVELY NUMBERED FORM <br />