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'The free Adobe Reader may be used to view and complef-}his form. However,software must be purchased to complete,sand reuse a saved form. <br /> File Original with DWR L) State of Califomia <br /> Page of <br /> Well Completion Report <br /> Refer totnstrucffonPamphlef State Well NumbedSite Number <br /> Owner's Well Number MW-5 No. e0157750N w <br /> Date Work Began 07/23/2012 Date Work Ended_7/23/2012 Latitude Longitude <br /> Local Permit Agency <br /> Permit Number 65313 Permit Date 7113/12 APRURS10ther <br /> Orientation OVertical O Horizontal OAngle Specify Name Olympian JV <br /> Drilling Method Auger Drifting Fluid Mailing Address 1300 Industrial Road#2 <br /> } <br /> city San Carlos State CA 1i 95602 <br /> 77 7through <br /> abandon 2"well to 30'and rout <br /> to <br /> Address 1022 Frontaue Road <br /> City Ripon ® San Joaquin�. <br /> Latitude �j5n itudeDep. Min... Sec map. Mn, c. <br />` Datum Q 'mal Le„ De7d ng. <br /> APN Book P e Parce _ <br /> Township :. =Ra n <br /> iFnn _ O Y_I <br /> firth N Well <br /> l Mo 'ficatioNRepair <br /> O Deepen <br /> O Other <br /> © Destroy <br /> Deacdbe procedures and mamrfals <br /> undo'GEOLOGIO LOG' <br /> I _ <br /> �T <br /> 0 Water Supply <br /> E]Domestic ❑Public <br /> Lu <br /> ©Irrigation []industrial <br /> ' 0 Cathodic Protection <br /> O Dewatering . <br /> 0 Heat Exchange <br /> �^. O Injection <br /> 0 Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> a !'south 0 Test Well <br /> ? Ilrahnte m describe dstsncerof well from rends.Wicinp,tencee, 0 Vapor Extraction <br /> rtaera,ate.and meth a map:'acre edMcmal paper If necessary. 0 Other <br /> P,—be accumm end o <br /> Depth to first wales (Feet below surface) <br /> 8 _ <br /> � .��` Depth to Static <br /> Water Level (Feet) Date Measured <br /> 4 <br /> Total Depth of BbiingHeel Estimated Yield` . (GPM) Test Type. <br /> kF <br /> '0' Test Length (Hours) Total Drawdown Feel <br /> Total Depth ompleted Well , a` Y Feet ]::.1 *Ma not be representative of a well's Ion term yield. { ) <br /> I Depthfrom holeTWall Outside rTpen , SII Ane Depth from <br /> Surface ype 1ateri 1 Thickness Diameter yeySurface <br /> FIIE r a n <br /> DescriptionFeet to Feet Ine <br /> Inches Inches Inches Feet to Feet <br /> V, <br /> t <br /> 3 <br /> lit <br /> d ❑Geologic Log I,the undersigned,certify thatihis report is complete and accurate to the best of my knowledge and belief <br /> ©Well Construction Diagram Name Caacade Driilina.L,.P. _ -- <br /> 0CeophysiC81 Log(s) Person,Firm or Corporation <br /> 3(332 Om Ci nd I e A Rancho Cordova CA 95742 <br /> ❑ SoilAftler Chemical AnalysesAddLEd�—' City state ZIP -- <br /> ❑Other_ its Map Signed 08/01/2(]12 938110 <br /> Attach additional Ihiotmation crit exists. - C-67 Licensed Water Well Contra a ! Dale Signed C-57 License Number <br /> DWR 188 REV.1120W IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />