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`The free Adobe Reader may be used to view and eomplet-this form. .Ho"ver.software must be purchased to complete, and reuse a saved form. <br /> File Original with DWR State of California D uq <br /> Pae of Well Completion Report <br /> Page Refer to lnawbon.pemphist State Well Number/Site Number <br /> Owner's Well Number MW-3 Na, e015774B N w <br /> Date Work Began 07/23/2012 Date Work Ended Z(?_3/2012 Latitude Lon nude <br /> Local Permit Agency San Joaquin County Environmental Health, 71 <br /> Permit Number65313 Permit Date 7113112 , APNfrRSrOther <br /> Orientation O Vertical O Horizontal OAngle Specify, Name Olympian JV <br /> i Drilling Method Au sr Drilling Fluid <br /> Mailing Address 1300.Industrial Road#2 <br /> -city- San Carlos State CA _2jp 95602 <br /> Overdrill to abandon 2"well to 30'and grout <br /> through Augers Address 1022 Frontacie Road <br /> City Ri on C , San Joaquinuin <br /> Latitude <br /> YV <br /> ! Deq., Min. Sec <br /> Datumcimal Decima IPkon <br /> „ 9• <br /> APN Book P e arse . <br /> Townshipj -tea on <br /> an r`fa ted O Ndr Well <br /> 1713rih Moification/Repair <br /> I <br /> 0-Deepen <br /> O Other <br /> 7 ; <br /> Q Destroy <br /> Deealbe pr dues and materials <br /> _ emdet'GEOLOGIO LOG' <br /> O Water Supply <br /> IV ❑Domestic ❑Public <br /> ;. w ❑Irrigation []industrial: <br /> x <br /> 7. <br /> ' ',` O Cathodic Protection <br /> O Dewatering, F r <br /> O'Heat Exchange <br /> tO Injection <br />` - O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> .'%�. "' ate ar deecribe distenceFot weH tram made,buildmps,fan7 O Vapor Extraction <br /> r< <br /> rivers etc.and attach a map.'Use sddldonai paper ifine we ary. O Other <br /> Pkese be aeeurNa and lets. <br /> n .y <br /> Depth to frst water (Feet below surface) <br /> Awe n Depth to Static <br /> Water LevelFeet <br /> ( ) Date Measured <br /> a ured <br /> Total Depth ofr(ng deet Estimated Yield* (GPM) Test Type <br /> 77 <br /> Test Len th <br /> Total Depth o�ompleted Well � ;r Feet <br /> g (Hours) Total Drawdown (Feet) <br /> May not be re resentalive of a well's Ion2 term yield. <br /> Depth from ehole Wall Outside �: Screen Slat Size' Depth from <br /> "Type ,: f}Aaterial } <br /> Su co <br /> i �. �� Thickness Diameter Type if Any iz Surface Fill Oescription <br /> Feet to Feet Inc�gs' " Inches Inches Inches I Feet to Feet <br /> 11 <br /> - a <br /> Geologic Log 1,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name Cascade Drillina.L'l.P. <br /> corporati <br /> CJ Geophysical Log(s) 6 2 rwn <br /> me Girt ler � ar ch9 Cordova CA 95742 <br /> ❑ Soil/Water Chemical Analyses A r s r— city State zip <br /> ❑Other Site Ma - Signed 08/01/2012 938110 <br /> I Anagh addinonai htrormaeon K it exltcts. 7 ucensed welgr It condador Date Signed C-57 License Number <br /> i .OWR 188 REV.1WOO IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />