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*The free Adobe Reader may be used to view and complete this�form However,software must be purchased to complete,save- nd reuse a saved form. <br /> File Original with DWR V 1� State of California <br /> Page " of Well Completion Report <br /> I'Referfo lnsfmdion Pamphlet State Well Number/Sae Number <br /> Owner's Well Number MW-5 _ "No, e0�5gg92 N W <br /> Date Work Began 07/11/2012 Date Work Ended 7/11/2012 Latitude Loa <br /> Local Permit Agency San Joaouin County Environmental Health <br /> Permit Number 0065150 Permit Date 6/11/12 1' APN/TRS/Other <br /> i <br /> Orientation OVertical O Horizontal OAngle Specify Name ATC Associates <br /> Drilling Method A42r Drilling Fluid <br /> Mailing Address 6602 Owens Drive#100 ' <br /> City Pleasanton State CA 94588 <br /> Overdrill to abandon 2"20'well .II' �ryeiry �'�° AW '-w-- ' <br /> Address 3555 West Hammer Lane` <br /> l` City Stockton Cq `ty San Joaquin <br /> L' Latitude _,rib.gitu � i._ <br /> Aee. Min. See eO. Sen <br /> Datum Deng. <br /> Decimal L _.Decimal�Ltong <br /> APN Book P e Parcel <br /> Township Ra 'on - <br /> -odn _ " O Ne'ty Well <br /> Mot'iif'icalioNRepair <br /> - ";,^ -' O Deepen <br /> - t 11 <br /> O Other <br /> • Destroy <br /> Deaenlno emava and materials <br /> Deder GEOLOGC LOG' <br /> ,I � Q Water Supply <br /> []Domestic []Public <br /> ❑Irt <br /> In ❑ <br /> igation Industrial <br /> O Cathodic Protection <br /> ,„ �• O Dewatering <br /> O Heal Exchange <br /> O Injection <br /> %,%z '' O• Monitoring <br /> O Remediation <br /> O Sparging <br /> 2„• +' South O Test Well <br /> .I, x ,� to"r a.dtt»asfenceaeell ram m.m Wlldnes,rm,cea, O Vapor Extraction <br /> dam,etc.aria emmamaF.uee eamuanel"eom aaeeem r OOther <br /> r—cseacw,mana cam Ime. <br /> �r <br /> Iry Depth to first water (Feet below surface) <br /> Depth to Static - <br /> . ;4v'v Water Level (Feet) Date Measured <br /> Total Depth of;,.4n-Kg ir„ Feet Estimated Yield` (GPM) Test Type <br /> Total Depth offlompleted Well ` h 4 0'7 Feet Test Length (Hours) Total Drawdown (Feet) <br /> ,as `Ma not be re resentative,of a well's longterm Yield. <br /> Mama <br /> Depthfrom ,"a'iPmholerxAgr.. +material Wall Outside Screen Slot Size Depth from <br /> Surface DIN djat®r '��� ';' etThickness Diameter Type If Any Surface Fill Description <br /> Feet to Feet, Inches '�",° Inches Inches Inches Feel to Fast <br /> II. <br /> Y} 1p <br /> Llf _._. �.�t• .•..,.. _., ._. _. .. <br /> ❑Geologic Log 1,the undersigned,r certify that this report is complete and accurate to the best ofmyknowledge and belief <br /> ❑Well Construction Diagram Name Cascade Dnlrlino,L.P. <br /> ❑Geophysical Lo S Person.Finn or Corpmedon <br /> at9( ) 32 it le Rancho Cordova CA 95742 <br /> ❑SoillVJater Chemical Analyses A pry stele zi <br /> ❑O other Site Mao Signed o✓ 07/17/2012 938110 P <br /> Attach additional Inkanatlon ff it e>usfs. C5]Lice star en OrareCar Date Signed C-57 License.Number <br /> DNR 18B REV.112008 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> P <br /> y <br /> • h. <br />