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'The free Adobe Reader may be used to view and wmplea+'his form However,software must be purchased to complete san,rid reuse a saved form. <br /> File Original with DWR State of California <br /> i Pae of Well Completion Report <br /> 1 g 'Retarto lasep Vw Pamphlet State Well Number/She Number <br /> Owners Well Number MW-6 :tI NO. e0156695 <br /> Date Work Began 07/11/2012 Dale Work Ended 7/11/2012 latitude Lon pude <br /> Local Permit Agency San Joaauin County Environmental Health <br /> Permit Number 0065151 Permit Date 6/11/12 APNrrRS/Other <br /> Orientation O Vertical O Horizontal OAngle Specify Name ATC Associates <br /> Drilling Method11 Auger Drilling Fluid Mailing Address 6602 Owens Drive#100 <br /> r+, <br /> City Pleasanton State_CA_Zip 94588 <br /> Pressure grout to abandon 2"22'well <br /> Address 3507 West Hammer Lane%a <br /> City Stockton '58r, San Joaquin <br /> Latitude gitud <br /> II Oee. Min. S '+rt6,ep. ' Is. <br /> Datum Q#.imal .DectmaLLbng. <br /> lib APN Book ` Pe Paroelr <br /> �k <br /> Township -Ra on ' <br /> a U N"Well <br /> 'fi`Mh" '..(� MdElification/Repair <br /> - O Deepen , <br /> OOther <br /> r ' Destroy <br /> 4 de� E e I <br /> mvw mexa.n <br /> In ueeer csoLooicMk <br /> wo <br /> Isn edts <br /> Tr O Water Supply" <br /> ❑Domestic ❑Public <br /> w ❑Irrigation ❑Industrial <br /> , ;. O Cathodic Protection <br /> �¢ O Dewatering <br /> Ad 5 '"^ 4 'tr '+aa <br /> ^"'tib. O Heat Exchange <br /> 0 Injection <br /> ''�'�'- ��*�;i' O' Monitoring <br /> - - "•M r' O Remediation <br /> O Sparging <br /> ^r✓° '` ,� South O Test Well <br /> O Vapor Extraction <br /> . - v:' i; p3ii`wo-m.«aeemx akmnwwven nom mem.daimnse,fence <br /> Hass emeeaemm.mep.urc.emucn.i P.ee.n�mceeeuye OOther <br /> O Depth to first water (Feet below surface) <br /> - Depth to Static <br /> ,,,1r�p` Water Level (Feet) Date Measured <br /> Total Depth of 0999- 's `� Feet Estimated Yield' �� - (GPM) Test Type <br /> Test Length (Hours) Total Drawdown (Feet) <br /> Total Depth d(�, ompleted Well n" fir. Feet <br /> �v w 'Ma not be reresentative of a well's Ion term field. <br /> Depth from "hole =-'.fix. "' r wall Outside Screen Slot Size Depth from <br /> Surface D5 r,,iw. pe .; i�gate el Thickness Diameter Type If Any Surface Fill Description <br /> Feet to Feet, Inches -ro Inches inches inches Feet to Feet <br /> 1 <br /> I! <br /> x` <br /> 5��17�i1 - <br /> ❑Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name Cascade Orillina.L.P. <br /> Person[3 Geophysical Log(s) 3632 Omec Circe corporeuoa Rancho Cordova CA 95742 <br /> ❑SoIINVater Chemical Analyses Ad 1N� �� city Siete zip <br /> +❑Other Site Map S19ned . r 07/17/2012 -938110 <br /> Anapn eddmonel inrormenpn nuawsls. C57 Ucensed eer IComsdor Date Signed C-57 License Number <br /> DWR 188 REV.1/2008 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUrIVELY NUMBERED FORM <br /> 1„i' <br />