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i <br /> The free Adobe Reader may be used to New and complete"a s form. However,software must be purchased to complete W% -'nd reuse a saved form. <br /> r File Original with DWR State of California , <br /> Page of Well Completion Report <br /> Owner's Well Number MW-11 Rererfa l[1115mehro6 Pamphlet State Well Number/Sae Number <br /> Date Work an 07/12/2012 HN2 e0156694 ITT1 <br /> Beg Date Work Ended 7/12/2012 <br /> Local Permit Agency San Joaquin County Environmental Health Lamude Longman <br /> Permit Number4065150 Permit Date 6/11/12 'llOriAPN/TRS/Omer <br /> ling M tion O Vertical O Horizontal OAing F Specify Name ATC Associates <br /> ling Memotl r Drilling Fluid <br /> • --- -".�.. - _. Mailing Address 6602 Owens Drive#100 <br /> ^' <br /> CityPleasanton State CA <br /> _Zip 94588 <br /> Pressure Qrourt to abandon 2"25 well f% <br /> Address .3555 West Hammer Lam a,`- <br /> City Stockton San San Joaquin <br /> I' Latitude grtudt 4b. 4ftL— y <br /> +l; Oen. Min. Sec. MN, <br /> Datum Dgcimal I.M. Decimal tong. - <br /> 4 APN Book P ge <br /> 0%arcel :. <br /> r Townshi -Ra on <br /> r, nbr-torn,c' 0 N Well <br /> prth - Mo ificatioN'TiRepair ri <br /> O Deepen <br /> O Other <br /> Destroy <br /> Destropl.eJuree mia notelets <br /> Ir enrosoLocic coo- <br /> . <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> ML + io ❑Igigation []Industrial <br /> O Cathodic Protection <br /> s e O Dewatering <br /> „ O Heat Exchange <br /> ' Olnjection <br /> - 0e Monitoring <br /> rs�y O Remediation � <br /> max• +6" ,�..x .. . O Spangling <br /> .. ,. ' 1 b South O Test Well <br /> `AV 141kI. {nZ:o-ne«aee«m.a'®waolweo o-om,..as,aalmnga,ren«., Q Vapor Extradlon <br /> end o uee.em.„u wr«u.aeeauy. <br /> au*� tuae PUe e«trare.natm. O Other <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of BQ ng '•j * `?�. Feet Estimated Yield' (GPM) Test Type <br /> ,�z'`f 'r � Test Length (Hours) Total Drawdown (Feel <br /> Total Depth o" Vompleted Well _ Feet ) -j <br /> *May not be re resentative of a well's lonq term yield. 1 <br /> Depth from mhole „ � s 'Matenal wall Outside Screen Slot Size Depth from <br /> Surface d1 `^ M,�- Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet Onc i6) (Inches) Inches Inches Feet to Feet <br /> IEEEtiw T� <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 Drilling,L.P. <br /> Person,Firm or Coryomtlon <br /> ❑Geophysical Logs) 3632 Omec Circle Rancho Cordova CA 95742 <br /> ❑ Soil/Water Chemical Analyses '^ city <br /> state zi { <br /> ❑+ Other Site Mao Signed b I �QQin 07/17/2012 938110 p f <br /> At1eM additional Infonnetlon if it easts. U7rloenseit Water Well Cont Mor Date Si ned C-57 License Number <br /> DWR 188 REV.1/2MB IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />