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i <br /> i! `The free Adobe Reader may be Used to view and comple' `tris form. However,software must be purchased to complete,save,end reuse a saved form. <br /> -� Fffp Original with DWR State of California nl Biu o <br /> 1; Pa•e of -''Well Completion Report <br /> g Refer tolnstwofionP,amphlet State well Number/Site Number <br /> Owners Well Number MW-1 No. 6015 State N w <br /> Date Work Began 07/23/2012 Date Work Ended 12 M� c Latitude Lon itude <br /> Local Permit Agency San Joaauia County Environmental- iealth <br /> Permit Number 65313 Permit Date 7/13/12 :3 Za APNfrRS/Other <br /> Orientation O Vertical O Horizontal OAngle Specify <br /> Drilling Method Auger Drilling Fluid <br /> -Industriaf Road#2 <br /> c San Carlos CA 95602 <br /> ' � _.1.`. Ci State�i <br /> Overdrill to abandon 2"well to 30'and grout <br /> through Augers Address 1022 Frontage Road <br /> City Ripon Co. ty San Joaquin <br /> Latitude gitud _ w <br /> Deg. Min. S [3ep. Putin. ec. <br /> Datum Imal Decima ?ong. <br /> u <br /> APN Book P e arcet " <br /> Township <br /> i. r.Ra Lpn <br /> S raw harir€ e' a " O N& Well <br /> 1 dilh Y O Mac7iflcation/Repair <br /> O Deepen <br /> O Other <br /> • Destroy <br /> Describe procedures and matedals <br /> undeerryr"GEOLOGIC LOG" <br /> L� O Water Supply <br /> J r- V t <br /> []Domestic [I Public <br /> n ❑Irrigation []industrial <br /> 4k - <br /> O Cathodic Protection <br /> '{" . ' <br /> .,, � Q Dewatering, <br /> Q Heat Exchange <br /> Q Injection <br /> ` j + O Monitoring <br /> O Remediation <br /> i Q Sparging <br /> xi ' <br /> South O Test Well <br /> .., Q Vapor Extraction <br /> .If lumtrate w desW6a dfamnca Diwali from reads.6ulldings,fences, <br /> dfa dress,etc.and atlaah a map:4llae addlti.n.papar II necessary. O Other <br /> Please be"W rate and a Ire, <br /> r.. Depth to first wate'r (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth ofTOP Feet Estimated Yield* (GPM) Test Type <br /> art `` Test Length (Hours) Total Drawdown (Feet) <br /> Total Depth d, ompleted Well Feet *M2not be representative of a well's long term yield. <br /> �a'J:'z�V•'iA4Kai.,x as.:. S F- _y _, •y ,r ,r <br /> Depth from rehole - e Material Watt Outside f; Screen Slot Size' Depth from <br /> Surface lilurli@t�r.,n' Thickness Diameter Type If Any i Surface Fill Description <br /> Feet to Feel Inches i Inches Inches Inches 1 Feet to Feet <br /> 1 fi <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 Driliin L`T. <br /> ❑ Lo 5 Parson,Firm or Corporation t <br /> Geophysical Y Log(s) 2 Circle. Rancho Qordova CA 95742 <br /> ❑ Sall/Water Chemical AnalysesA r city State Zip <br /> D Other Site Map Signed 08/01/2012 938110 <br /> Attach additional hiformalion IT It exists. C57 Licensed Water Contractor Date Signed C-57 License Number <br /> DWR 188 REV.112008 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVEEY NUMBERED FORM <br /> F <br /> ;y <br />