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i { f <br /> 'The Adobe Reader may be used to view and completes this form. However,software mus!be purchased to complete,s� '..and reuse a saved form. <br /> Fife Ori nal with DWR <br /> Stale of California <br /> Well Completion Report l <br /> Page Of ReFerto Ins"ctlon Pamphret State Well NumberlSite Number <br /> Owners Well Number MW-2 No. e0148220 N w <br /> Lon Rude <br /> Date W rk Began 02/13/2012 Date Work Ended &13/2012 <br /> Latitude <br /> Heallb <br /> Local P it Agency APNlTit510ther <br /> Permit <br /> mbar Permit Date 1118/12 �.� �.. .��x <br /> Ori trtatfon OVertical O Horizontal OAngle SPO&Y Name Arcadis # <br /> Drilling Method Au r Drilling Fluid Mailing Address 950 Glenn Drive Suite 125 <br /> C Folsom i State Cir 95630 <br /> Pressure rout to abandon 65'well <br /> Address W '" <br /> IStockton ' Cby, San Joaquin <br /> City <br /> Latitude 31 gitud"" .__ <br /> Daq. Min. Sec€ Y 0Ix7. Min Sec- <br /> Datum 'z mai _a _a �_�De«mal, ong <br /> APN Book l Paige s�-'`Parcel�F ' <br /> Township <br /> l s O N&Well <br /> 'l 'Na '°' O Mo&ification/Repair <br /> kx O Deepen <br /> OOther <br /> Destroy <br /> `.rti" Deavibe procedures and matedah <br /> under"GEOLOGIC LOG' <br /> yP " <br /> O Water Supply <br /> i 1. x �• ❑Domestic ❑Public <br /> " s <br /> []irrigation ❑Industrial <br /> i'4. w <br /> O Cathodic Protection <br /> 0 Dewatering <br /> Heat Exchari --. <br /> 7 ;t O Injection <br /> l 'ke O Monitoring <br /> O Remediation <br /> 0 Sparging <br /> a, xSouth O Test Well <br /> ' m dmdbe 4atenea Mwen from nada,bUIMMps,fences, O Vapor extraction <br /> rw—,ate.and adadi a map.Uaa'admmal paper If nerxesary. O Other <br /> 1. Pba baaearaaa iml <br /> � ,, Depth to first,water (Feet below surface) <br /> Depth to Static <br /> I nrE.9 Water Level I' (Feet) Date Measured <br /> Totalpth of BfiNN6 ... Feet Estimated Yield* (GPM) Test Type <br /> :fit Test Length' (Hours) Total Drawdown (Feet) <br /> Total pth of;Compleied Well Feet 'May not be"representative of a well's IoM term yield. <br /> :.. <br /> De from $orehole wall Outside Screen Slot Size i Depth from <br /> Su` ce DfpiFiatert=•. "Nk Thickness Diameter Type IfAny Surface Fill Description <br /> Feet Feet Inches • .Inches inches Inehes Feet to Feet <br /> 4T­ <br /> 77, <br /> 77, vT <br /> i��v <br /> ❑ eologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> CO ell Construction Diagram Name Cascade Ddllin L.P <br /> Person,Flrrfl or Corp=bon i <br /> ❑ eophysical Log(s) 632 Om Circle ' Rancho Cordova CA 95742 <br /> ❑ oill Mater Chemical Analyses y city state zip <br /> 0 r Site M Signed 03/20/2012 938110 <br /> At�ch add onal Inf matkm If It aAffW. C-57 �cen alar n corwa Date Signed C-57 License Number <br /> DWR 188 EV.1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> i <br />