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File Original with OWR - v----no reuse a saved form. <br /> i <br /> omlever,software must be <br /> ly State of California p p § <br /> 5 <br /> The free Adobe Reader may f>a used to view and complete forWel Completion ReW A, phR@haUFt complete,sa � y• 0� <br /> F <br /> Pae of <br /> Stale Well Number/Site Number <br /> Owners Well Number MW-211 No. e0156693 <br /> Date Work Began 07/11/2012 Date Work Ended 7/1112012 - Latitude Longitude <br /> 1 Local Permit Agency San Joanuin County Environmental Health <br /> Permit Number 0065150 Permit Date 6/11/12 1'- APNrtas/other <br /> Orientation O Vertical O Horizontal OAngle Specify Name ATC Associates <br /> Drilling Method A er Ddlling Fluia Mailing Address 6602 Owens Drive#100 <br /> f <br /> City Pleasanton StateCA 7ip 94588 <br /> Overdrill to abandon 2"32'well at4q `".,` t"q';• .',;.WI@L'o a, t�`a . -. <br /> Address 3555 West Hammer Lane <br /> City Stockton Coni+ San Joaquin <br /> u, Latitude gltud 4fLwi <br /> "Min. S '. MIn. Sec <br /> Datum O�,Cimal L ( ". .'Decimal Lrong. <br /> APN Book P e Parcel <br /> q� <br /> Township ag S d g ion <br /> el an. a ANWHOCO Nov Well <br /> I rth <br /> I, '.Q Mo"ification/Repair <br /> VIO Deepen <br /> O Other <br /> Destroy <br /> _L <br /> .nd mete leis andx�%EOLOCIC LOG' <br /> ,.. Q Water Supply <br /> ❑Domestic [:]Public <br /> e m ❑Irrigation ❑Industrial <br /> w <br /> Q Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> O Injection <br /> 'T"s " AM'*" '-At6{ 0 Monitoring <br /> Vd 6i O Remediation <br /> l - O Sparging <br /> O Test Well <br /> South Q Vapor Extraction <br /> ' �V% " Bw`mme or meo-me.tanm w..n xo,n ro.m e.Ianw.r.�.., <br /> .' . mae etc end mew mro u...dmaonel wce.umceeaen•. Q <br /> Other <br /> •: 3x vwsse n.:mret..eee I.a <br /> 1 L va rieetsdalN l ' . _v <br /> Depth to first water (Feel below surface) <br /> IIIIII �, Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of 6p71ng „ ,�., Feet Estimated Yieltl <br /> ", (GPM) Test Type <br /> Tota <br /> ro - ++ 9 Test Length (Hours) Total Drawdown (Feet) <br /> I <br /> Depth mpleted Well . a't., <br /> w"oFeet <br /> •� IrMay not be re resentative of a well's Ion tea eld. - c <br /> 1 ►d_ eFt 1 <br /> Depth from y Material wall j Outside Screen Slot Size Depth from . <br /> i Surface am r' �:', "fL' r Thickness Diameter Type if An Surface Fill Description <br /> Feet W Feet Inclie 3;,`sP Inches Inches Inches Feet to Feet <br /> 5k <br /> I' <br /> v- <br /> I ❑Geologic Log 1,the undersignetl,certify that this report is complete and accurate to the best of my knowledge and belief <br /> 13 Well Construction Diagram Name _Cascade Drillina,L.P. <br /> ❑Geophysical Log(s) Person,Finn ar corporaecn <br /> 632 Ome Circle Rancho Cordova CA .95742 <br /> ❑ SoIINVatef Chemical Analyses fir, Addre city stare Zip _ <br /> O Otter Site Map Signed t/t /1 a�Q v— 07/17/2012 938110 <br /> Attach additional Monosson Hit eldsts. C-57 Liven C im,as Date Signed C-57 License Number <br /> DWR 188 REV.12006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> iI <br /> II <br />