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-\ "The fre 'Adobe Reader maybe used to view and complet,this form. However,software must be purchased to complete,s* ' and reuse a sawed form. <br /> File Ori�nal with DWR U State of California <br /> Well Completion Report <br /> !ti I <br /> Page - 11 of _ Refer to Instruction Pamphlet State well NumberlSite Number <br /> Owner Well Number MW-5 N°• e0148221 " w <br /> Latitude Lon iEu <br /> Date W rk Began 02/13/2012 Date Work Ended } <br /> de <br /> Local P it AgencyHAFIlth APNITRS/Other <br /> Penna mbar Permit Date 111$112 !j , <br /> . ... <br /> MEW <br /> orientation (D Vertical 0Horizontal OAngle Is <br /> Specify Name Arrad i. <br /> Drilling�Method A er Drilling Fluid Mailing Address 950 Glenn Drive Suite 125 <br /> Cily Folsom1 State CA 1p 9'-0-- <br /> I Pressure rout to abandon 62'welt/ <br /> I Address' n I _ <br /> 'n C San Joaquin <br /> 4 <br /> ckt <br /> �Y <br /> I <br /> City Sto !§ 1ng>tud '_� <br /> Latitude Min. $ec g > 1 Mln . <br /> Datum De�,imai Lk��aDectmal Long <br /> I; P e "Parcet <br /> APN Book9, T--�— <br /> Townshi Ji Ra <br /> M Neer Well <br /> l O Moification/Repair <br /> "=<O Deepen <br /> Other <br /> Destroy <br /> Deearoe prooW"and me4dela <br /> under'GEOLOGIC LOG' <br /> Q Water Supply <br /> . ❑Domestic []Public <br /> w <br /> ❑Inigation ❑Industrial <br /> Q Cathodic Protection <br /> Dewatering <br /> O Heat Exchange <br /> w 0 Injection <br /> „t:. O Monitoring <br /> O Remediation <br /> O Sparging <br /> ;.« <br /> 5o'uth O Test Well <br /> Nuebete or dmoribe ulewme woven from roods,b lk inpe,Teneea, O Vapor Extraction <br /> -. Men,etc.and ettadi a map.Vee WdIbnal papa If necessary. O Other <br /> iV% ,r - PI be=cumte endo lefe. <br /> Depth to first!water Feet below surface <br /> Depth to Static ( ) <br /> Water Level (Feet) Date Measured <br /> Lolal,Depth of Boring p � Feet Estimated Yield' (GPM) Test Type <br /> Test Length'!` (Hours) Total Drawdown (Feel} <br /> D pth of Completed Well Feet <br /> M `Ma not be re resentative of a well's long term yield. <br /> Depth,from Horehol9 R 5 � atgrl l wall Outside Screen Slat Size _ Depth from <br /> Surace Dii6al Thickness Diameter Type If Any Surface Fill Description <br /> Feet w Feet Inches Inches Inches Inches 'Feet to Feet <br /> I l't a <br /> I� <br /> ws'` IF <br /> If <br /> ❑Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑t ell Construction Diagram Name Cascade Drilling.L.P. 1F „ <br /> Person,Firth or Corporation <br /> ❑Geophysical Log(s) 3.632 0I CircleRancho Cordova CA 95742 <br /> © oillWater Chemical Analyses :;. Cny Stage zip <br /> El r Site Man Signed 03/20/2012 938110 <br /> Attach add-Alanal inibmuldon If ft exists. 7 Licensed water ontractor ii Date Signed C-57 License Number <br /> am 188 iEv.imom IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> I � <br />