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'The free Adobe Reader may he 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 State of California DWR Use On OoNof'FAI fh:•:- <br /> Page 1 of 1 Well Completion Report <br /> Refer to frishuelfan Pamphlet State Wall NumbefMile Number <br /> Owners Welt Number MW-1 No. e0157708 I I T—N1Nr <br /> Date Work Began_� /'L�^/12 Date Work Ended C1&4-/t7.- Latitude Longitude <br /> Local Permit Agency San Joaauin.E7=—y Environmental Heallh Department „ <br /> Permit Number 65313 Permit pate 7113112 APNrrRS/Other <br /> W611' <br /> 'Goo is Lo <br /> Otivrter: <br /> Orientation O Vertical 0 Horizontal OAngle Specify Name Olympian JV <br /> Drilling Method Hollow Stem&Mer OrHling Fluid Mailing Address 1300 Industrial Road,Suite 2 <br /> 06pth from Wi face Description <br /> merenal, 'he size,chlor etc _ cit man Carlos State CA 71 3407Q <br /> 0 30 l3verdrilled well burin via hollow stern au er - "��" •" "" ,,.:,, We11:L.ocetltiri:.i�.:-�. .., ::-..: .:., <br /> Address 10-22F_roniago Rod <br /> City Ripon minty San Joa tin <br /> Latitude _ a N Longitude __ - ,? w <br /> Dan. Min. Sec.•.• Deo. MIn. "Sar- <br /> Datum DecimalLat: ? _.Decirnal.Long.-t�fAV. <br /> APN Book 261 Page 020: _ Parcel 12 <br /> Township 2S Raai 9.6�-= Section A9 <br /> .Location SRetch <br /> ste�a; 5ttadarna t�aeener� rsl s�iaa "" ONew Well <br /> Nanh <br /> O Modification/Repair <br /> dt ,�. �ior+Ztt nv O Deepen <br /> O Other <br /> O Destroy <br /> mwer•r�WKW IG w�m �ro�a 4 <br /> oucciccOWos <br /> Planht Uses;:_-;., <br /> w-� O Water Supply <br /> _ ❑Domestic OPublic <br /> 1711nigatfon ©Industrial <br /> p1J O Cathodic Pratectlon <br /> aw-9 o Dewatering <br /> O Heat Exchange <br /> BroAiy 1-c,,ne, is 313'N JiKldi O]njaction <br /> O Monitoring <br /> retttce�+, Ct i5 g� W o� O Remediation <br /> O 5parging <br /> South O Test Well <br /> Itdsueaaraa.owanranm01%Wfo msn%wWJrQ%kmuk O VaporF-draction <br /> 0=11'. <br /> 11'.e�ldallashamap.Use adddlnrmlwpeff mesmy O Other <br /> Pieaze Da aeeurale end a I.t.. <br /> afar.-,Levef.apid Yleld-of Completed UIIeII : r, :'.:::-;.:, <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring Feet Estimated Yield` (GPM) Test Type <br /> Total Depth of Completed Well Feet Test Length (Hours)Total Drawdown (Feet) <br /> *May.not be ra resentative of a well's long term yield. <br /> ""ApnufarMate�ial.;,..,. <br /> Depth from '.Borehole Wall Oulside Screen Slot Size Depth from <br /> Surface Dfatnater Type Matorlal Thickness Diameter Type If Any Surface Fin Description <br /> Feet to Feet Inches), inches Inches) (Inchasl Feet to Feel <br /> c Attaahment5 Certification Stateinent:- <br /> ©Geologic Log 1,the undersigned,certify that this report Is compfele and accurate to the best of my knowledge and belief <br /> ©Well Construction Diagram Name Cascade Drilli <br /> Peron,Flan oY Corporallan <br /> ❑Geophysical Logs) 3632 Omee C'rcle Rancho Cordova CA 95742 <br /> ❑Soll/Water Chemical Analyses city sate zip <br /> Cl Other Signed ���P%..I- 04/12 938110 <br /> Attachaddfaonallararmafrn anexlala s alar weecontreao. Date Signed C-57 License Number <br /> GWR 188 REV.trl.m IF ADpmONAL 8PACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />