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-The Adobe Reader may be used to view and complete this form. However,software must be purchased to complete,sfi'�.,and reuse a saved form. s- <br /> Fite Ori nal with DWR State of California �1 <br /> Well Completion Report <br /> Page of Railer to Insinwiffon Pamphlet state Well NumberlSiteMINIumberOwner Well Number AS-1 No• 90148214 NDate W rk an 02/08/2012 Date Work EndedrLatitude r.....uin Coiji-ity Fnvirnnmental Health Local P ik Agency;, -r APNrFRstuthe <br /> Permit mber 64190 _ Permit Date t118112 II' , <br /> Orf Irtatton OVerGcal O Horizontal OAng1e Speafy Name Ar--is <br /> anllina Method Au er brg Fluid _ Mailing Address 950 Glenn Drive Suite 125 <br /> I <br /> City Folsom` # State C_ 7i 95630 <br /> Drillout 2"64'well with 8"au er5 and rout u � � �:,: � k-�f: <br /> Address 1612 W Hiirnmer <br /> City Stockton Coiaty San Joaquin <br /> Latitude i1 ngttud�er> <br /> Deg. Min. :.. `1 <br /> Il Datum Decimal L AV 's Decimal bm <br /> Lang t <br /> APN Bookla' ''P�e — "'Parcels `sz <br /> Township �� •Rank: <br /> NtW Well <br /> Ii O Moetfication/Repair <br /> -tmJ r .O Deepen <br /> p Other <br /> gab • Destroy <br /> ,, :t.; rhsmPoe ptuedaes and materlah <br /> '� x* under WoLOG1c too• <br /> -' O Water Supply <br /> ❑Domestic ❑Public <br /> m []irrigation D Industrial <br /> x ui <br /> O Cathodic Protection <br /> ' L O Dewatering <br /> O Heat Exchange r. r <br /> s . :.. O Injection <br /> O Monitoring <br /> g�ax �� O Remediation <br /> z b O Sparging <br /> st i South O Test Well <br /> ,n W m daamlbe 6atanca.1wee tam roads,bLdtangs,feria, O Vapor Extraction <br /> rirma,etc.mid attach a map.Use'eddltlenalper pah necessary. O Other <br /> Room be accurate"W c .. <br /> . z <br /> Depth to firstlwater (Feet below surface) <br /> Depth to Static <br /> Water Level I, (Feet) Date Measured <br /> Total D pth of Feet Estimated Yield` (GPM) Test Type <br /> " r ,. Test Length�� " (Hours) Total Drawdown <br /> Feet (Feet) <br /> Total D pth olompleted Well <br /> "MAy not be representative of a well's Iona term vield. <br /> : o- <br /> Dept from t3oiehole wall Outside Screen $lot Size I Depth from <br /> �IWaterl <br /> Su ce DliArM"! .{YPa Thickness Diameter Type if any Surface FIII Description <br /> Feet D Feet Inches Inches Inches Inches Feet to Feet <br /> �., !f <br /> ❑ eologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑ ell Construction Diagram Name Cascade DdIlina-L.P. t <br /> ❑ eophysical Log(s) Person.Finn or Corporation .i <br /> 3632 Omec Circle n h 'Cordova CA 95742 <br /> ❑ IUWater Chemical Analyses Add �- i city Stme Zp <br /> 0 Ma <br /> ther Site n Signed 03120/2012 938110 <br /> Attaa,addi 1.1.01 IrAorrnation 9 ewscs. - �-^�ucensellWiiIiar Well Convector n_ Dade Signed C-57 License Number <br /> DWR 188 REV.1=D8 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> i <br />