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File Original wit b <br /> 'The free Adobe Reader may be used to view and complete mis fort However,software must be purchased to complete,sal---nd rause a saved form. <br /> tj State of California <br /> � h DWR <br /> Well Completion Report <br /> Page of .Rerertomvrnolon Pemphk <br /> O*wr 's Well Number MW-4 "I'No• Sol56690State Well Number/Site Number <br /> Date Work Began 07/10/2012 Date Work Ended 7/10/2012 Latitude Longitude <br /> Local Permit Agency San Joaouin Countv Environmental Health <br /> Permit Number 0065150 Permit Date 6/11/12 - APNrtRs/Omer <br /> Orientation O Vertical O Horizontal OAngle Specify Name ATC Associates <br /> Drilling Method Auger Drilling Fluid Mailing Address 6602 Owens Drive#100 <br /> t. - , - <br /> State Pleasanton 94588 <br /> Pressure grout to abandon 2"27'well <br /> ""J1 T�.`T'vtitTxt31�. 'YT _. <br /> Address .3555 West Hammer Lana <br /> City Stockton C San Joaquin <br /> Latitude <br /> gitg d ' _yy <br /> Dep. : Min. s Decimal a. Nhd ec. <br /> Datum Decimal La_ Decimald1ong. ° <br /> APN Book—VP a Parcef ATF <br /> —L-- <br /> owns -Ra on <br /> If Me" WOE <br /> II " ; { ,8 "�r fomdid1-na O N Well <br /> 'North ' Mc, ification/Repair <br /> O Deepen <br /> lh O Other <br /> • Destroy <br /> oedcdna wad mamdan <br /> aaaer•aaMoLCGIaolcLoc• <br /> V O Water Supply . <br /> il= F 10 _ ❑Domestic []Public <br /> w ❑Irtigation []Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> O Heat Exchange <br /> r = akl O Injection <br /> O Monitoring <br /> Remediation <br /> O Spangling <br /> South O Test Well <br /> O Vapor Extraction <br /> ftens.ew.and ao-aoe a a•n.we adadooal page If aceMeY <br /> vanaa ae,Ata and e O Other <br /> elf. :. _ A kWett_ -210405 <br /> , ,. "+ a A01 Depth to first water (Feet below surface) <br /> Depth to Static <br /> ` ,. Water Level _ (Feet) Date Measured <br /> Total Depth ofwlfig , �Feet - Estimated Yield' (GPM) Test Type <br /> Total Depth oompleted Well `r Feet Test Length (Hours) Total Drawdown (Feet) <br /> s 'Ma not be re resentative of a well's Iona term vield. <br /> Depth from iS'. holer 'pe MateI Wall Outside Screen Slot Size Depth from <br /> Surface DiaBte y,,.: `11a Thickness Diameter Type If Any Surface Fill Description <br /> Feet to Feet (Incha's' "'' Inches Inches Inches Feet to Feet <br /> do- <br /> fpr <br /> 1k <br /> 4 <br /> 0 <br /> - <br /> ❑Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> 11 Well Construction Diagram Name _Cascade Drillinct L.P. <br /> ❑Geophysical Logs) 3632 Pec Circip Firn or cpmomtipa Rancho Cordova CA 95742 <br /> ❑ SoillWater Chemical Analyses '^ Ad s 1- � city stere Zi <br /> ElOther Site Map Signed �h/ /�(�—�r�D 07/17/2012 938110 - p <br /> Attach additional inrormation it It exists. c T LICENO water well onveaor Date Slimed C-57 License Number <br /> DVIR 188 REV,1/2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> ar <br />