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' 'The free Adobe Reader may be used to view and complete+his form. However,software must be purchased to complete,ss" ,and reuse a saved form. <br /> f. <br /> - Fife Original with DWR �.om:a - <br /> 9 State of Cali <br /> Y. Pae of Well Completion Report <br /> Page ReferrolnsrrUd=Pamphler State Well Number/Site Number <br /> Owner's Well Number MW-2 No. e01$7794 N w <br /> Date Work Began 07/23/2012 Date Work Ended 7/23/2012 Latitude Longitude <br /> Local Permit Agency-San JoagI jn County Environmental_Health <br /> I� Permff Number Q,§1,313 Permit Date 7/13/12 APN/TRS/Other <br /> Orientation O Vertical O Horizontal OAngle Specify Name OI m iari JV <br /> Drilling 149ethod Auger Drilling Fluid Mailing Address A 300 Industrial Road#2 <br /> f <br /> city San Carlos State CA Zi 95602 <br /> Overdrill to abandon 2"well to 30'and grout <br /> through Augers Address 1022 F.rontaue Road <br /> 4 City Ri on Co, <br /> an Joaquin <br /> Latitude <br /> Dern. Min. S �p t ec. <br /> Datum D :mal ecima prong, <br /> i APN Book P e Parcel <br /> Township i Ra nn <br /> of 0 N Well <br /> ith Mem <br /> o'6ificatioNRe air <br /> P <br /> 0 Deepen <br /> 0 Other <br /> • Destroy <br /> Oesedbe pmcedures and mater'iale <br /> - undn'GEOL06l0 LOG' <br /> tfie <br /> jte�d <br /> [ORemediation er Suppomestic(aigation IF hodic Pr <br /> watering <br /> " Heat Exchange ' <br /> ction <br /> . itoring <br /> ediation <br /> rging <br /> ,South. t Weil <br /> illuatretea tleenlbp dlytanca ofrrep from roads,bulldirspa,fences, or Extraction <br /> end attach a map.Llae adcWmnl paper ifneceeeary. gr <br /> ' Aleese be accurate and <br /> - % El Y <br /> Depth to first water (Feet below surface) <br /> Depth to Stage <br /> Water Level (Feet) Date Measured <br /> Total Depth ofg M;JFpet Estimated Yield* (GPM) Test Type <br /> Total Depth offampleted Well Feet <br /> 3 _ Test Length (Hours) Total Drawdown (Feet) <br /> , <br /> mr <br /> *May not be representative of a well's long term yield, <br /> I' C•.- R ., .' mss_ - _ y, .. _, :,_'. -jd,w ,��, ., <br /> I Depth from hole T'YPef > Wall y Outside. .Screen Slot Slzw Depth from <br /> .. fAateifal <br /> Surface fSfe_ �$ Thickness Diameter Type if Any Surface Fill Description <br /> Feet ro Fee E Inctm�s"' Inches Inches Inches a Feet to Feet <br /> r ❑Geologic Log I,the undersigned,certify thatathis report Is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name Casc rillin L:P. <br /> 13 Geophysical LO Person,Firm or Corporation <br /> fY g(S) 3632 Omec Circle Rancho Cordova CA 95742 <br /> ❑ SoillWater Chemical Analyses Addres city state lap <br /> 0Other Site Map Signed )r�e^ 08/01/2012 938110 <br /> Attach eddttlonal iMarration it it exists. as7 ucense Wena We 'rJr - -Date Signed C-57 License Number <br /> DWR 188 REV,WOW IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> 1 <br /> i 3: <br />