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' "The free Adobe Reader may be used to view and complet-this form. However,software artist be purchased to complete, ,and reuse a saved form. <br /> File Original with DWR State of California <br /> Pae of Well Collnpletiion Report <br /> Page Refer tolnsfrudfonPamphfet State Well Number/Site Number <br /> Owner's Well Number MW-6 Mo".e0157770 N w <br /> Date Work Began 07/26/2012 Dale Work EndedLatitude Longitude <br /> Local Permit Agency <br /> Permit Number 6531 Permit Date 7/13/12APNrrRS/Other <br /> �I <br /> s: <br /> Orientation O Vertical O Horizontal OAngle Specify Name Olympian JV <br /> Drilling Method Auq2r Drilling Fluid <br /> :. Mailing Address 1300 Industrial Road#2 <br /> City San Carlos State CA Zi 95602 <br /> Overdrill to abandon 2"well to 30'and grout <br /> through Augers Address a Road <br /> City Ripon —San Joaquin <br /> �r— <br /> Latitude <br /> itu -�. <br /> d <br /> �N <br /> Dep, Mln. S esr. Min. <br /> Datum Decimal L Decimal no. <br /> APN Book P e Farce <br /> Township €i .-.Ra 106WIffS on <br /> e .' h O N3 Well <br /> Mo ificatiorlRepair <br /> O Deepen <br /> O Other <br /> • Destroy <br /> Describe procedrvea and materials <br /> under'GEOLOGIC LOG" <br /> s.- O Water Supply <br /> ©Domestic ❑Public <br /> - <br /> [3 Irrigation ❑Industrial <br /> �r' 8r <br /> O Cathodic Protection <br /> J O Dewatering. T <br /> i <br /> 1 O Heat Exchange <br /> O Injection <br />` O Monitoring <br /> O Remediation <br /> O Sparging <br /> is South <br /> O Test Well <br /> ere ordescribedfaterMe`af xeil from roads,JbdldUfga,fences. O Vapor Extraction <br /> - rime,etc.and adech a map:1 Use addFdonet paper if neceesery. O Other <br /> Pkasa be aeeurHe and <br /> W <br /> gAm�? .. ... � <br /> DDepth to first vrater (Feet below surface) <br /> epth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of nn9 _ Feet i <br /> Estimated Yield <br /> (GPM) Test Type <br /> Total DeTest Length (Hours) Total Draw <br /> down (Feet) <br /> 'Ma not be re resentative of a well's Ion term yield. <br /> � , .,. <br /> Depth from igrahole wall Outside 'aL Screen Slot Size I Depth from <br /> x pe �: tNeteraf <br /> Surface OI Thickness Diameter Type If Any Surface Fill Description <br /> Feet to Feet loc�e�'s' * Inches Inches Inches Feel 'to Feet <br /> tet;_ <br /> 1 <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 Dilillina,LP. <br /> .Person,Finn or Corporation <br /> i ❑Geophysical Log(s) 3632 Omec Circle Rancho Cordova CA 95742 <br /> ❑ Soil/Water Chemical Analyses - Aa Zip <br /> city stale <br /> El Other Site Map Signed 08/01/2012 938110 <br /> tate <br /> Attach eodibonal intarmetlon M Ir wrists, c Liven water Well contractorDate Signed C-57 License Number <br /> DwR 188 REV,112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />