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i 'The free Adobe Reader may be used to view and complete.this form. However,software must be purchased to complete,save-and reuse a saved form. <br /> File Original with DWR II State of California ;v '%iPTp: =pOctt'r.=Srab3. a1rC n" eE.giid;''fd`i... <br /> Well Completion Report <br /> Page of -Referto instruction Pamphlet <br /> Owner's Well Number MW-3 ,"NO. e0156689 State Well Number/Site Number i <br /> Date Work Began 07/10/2012 Date Work Ended 7/10/2012 FL Latitude Lon itude <br /> Local Permit Agency San Joaauin County Environmental Health <br /> Permit Number 4465150 Permit Date 6/11/12 APN/TRS/Other <br /> Orientation (E)Vertical 0 Horizontal OAngle Specify Name ATC Associates <br /> Drilling Method Auger Drilling Fluid Mailing Address 6602 Owens Drive#100 <br /> Y <br /> y <br /> City Pleasanton State_CA_ZID 94588 <br /> Pressure grout to abandon 2"30'wella- <br /> Address 3555 W a g <br /> City Stockton _ o San Joaquin <br /> Latitude W <br /> ./ eawDep. Min. S 'arOep. Mtn. ecDatum DWst LDerdmal 'ong. <br /> APN Book Page arcet .es . <br /> Township a e. Se' ion ' <br /> I. tc a� htlia r otmA te' .O Nee,—,yWell <br /> "fl6rlh no_ O MoflihcationlRepair <br /> O Deepen <br /> O Other <br /> Destroy <br /> "} peealpe Pro edu d inuifth <br /> under EMOQIC LOG <br /> O Water Supply <br /> []Domestic []Public <br /> '. "R g ❑Irrigation ❑Industrial <br /> � W <br /> n 4 O Cathodic Protection <br /> ' .,' O Dewatering <br /> T'k1r O Heat Exchange <br /> 0Injection <br /> ` 0 Monitoring <br /> O Remediation <br /> O Sparging <br /> ;t <br /> .k' s '!i X South O Test Well <br /> 1 'Vit- T �Mtreb ordmvite bAence orweY kwn roedq UWltlhge,hntty O Vapor Extraction <br /> -ea.C4` =f.-.3n. : M k.end etleMemep Uu etldMonelPWeremceawry. O Other <br /> •^•. Pbae be ecaMand Nle <br /> I Depth to first water (Feet below surface) <br /> Depth to Static <br /> •> 1Vt-:.r Water Level (Feet) Date Measured <br /> Total Depth of B'Nng _ ¢ Peet Estimated Yield' (GPM) Test Type <br /> Total Depth ORCOmple[ad Well "" Sr r oir'*. Feet Test Length (Hours) Total Drawdown (Feet <br /> 'Ma not be representative of a well's long term yield. <br /> Inc 1a ype . ateritil .-. � finch a Diameter Semmen_ Slot Size <br /> Any Depth from DescriptionSurface Fill <br /> De from hole Wal <br /> Surface D <br /> Feet to Feet' 's Inches Inches Feet to Feet - <br /> �rYt <br /> "Fite <br /> eco <br /> gym. <br /> ❑Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> 13 Well Construction Diagram Name_Cascade Drlllino.L.P. <br /> ❑Geophysical Log(s) 3632 OmecoCircle orcorpere8on Rancho Cordova CA 95742 <br /> ❑ SoiVWater Chemical Analysescity stele Zip <br /> ElOther Site Mao Signed A 6CT�!r 07/17/2012 938110 <br /> Attach eddifonel infinnavon 0 it exists. Cb7U.r.d star 1I 1m dor Date Signed C-57 License Number <br /> DWR 188 REV.1r20DB IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> f <br /> of <br />