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'The free Adobe Reader may be used to view and complern Phis form. However,software must be purchased to complete,SA"and reuse a saved form. <br /> File Original with DWR State of California •. <br /> Page of Well Completion Report <br /> Refer to 1nsfr0Won`Pamph1et State Wall Number/Site Number <br /> Owner's Well Number MW-7 No. e0157743 Nw <br /> Date Work Began 07/23/2012 Date Work Ended 3123/2012 Latkude Longitude <br /> Local Permit Agency San Joaauin Counly,Environmental Healtb <br /> Permft Number6,,5313 Permit Date 7113/12 ; APNfrRS/Other <br /> Orientation O Vertical O Horizontal OAngle Specify <br /> Name OI m iaA JV <br /> Drilling Method Auger Drilling Fluid <br /> Mailing Address 11300 Industrial Road#2 <br /> city San Carlos State CA _Zip 95602 <br /> Overdrill to abandon 2'well to 30'and grout o. <br /> through Augers Ir Address 1022 , o t d VL <br /> City Ripon C San Joaquin <br /> Latitude L gitu a w <br /> Desi. Min. 5 �Jn. Sea <br /> Datum imal L Decimal ng. <br /> APN Book - Pae arse <br /> Township611 Sion <br /> �1E <br /> A O INWell <br /> I. h <br /> Mo ificatiori(Repair <br /> O Deepen <br /> O Other <br /> - Destroy <br /> Describe pwedurrs and matevials <br /> _ mder'GEOLOGIC LOG' <br /> s O Water Supply <br /> _ ©Domestic [3 Public <br /> ©Irrigation ❑industrial <br /> 0 Cathodic Protection <br /> M O Dewatering <br /> I� O Heat Exchange <br /> O Injection <br /> ' � '�. O Monitoring <br /> O Remediation <br /> Fj O Sparging <br /> O Test Well <br /> d.South 0 Vapor Extraction <br /> .rl -,111ushata a describe distmce-el veil from roads,lsdldlnps,Fences, <br /> dyers,etc.and anach a map:i Use add limat paper if necessary. O Other <br /> Please ha accurate ar d c late. <br /> Depth to first Static water <br /> � Depth to Sta (Feet below surface) <br /> " Water Level (f=eet) Date Measured <br /> Total Depth of y gm deet Estimated Yield' (GPM) Test Type <br /> - Test Length ) <br /> Total Depth completed Well ' ° Feet g (Hours) Total Drawdown (Feet) <br /> `Ma not be representative of a well's I2M term yield. <br /> De from ore � Vitali Outside r`.Screen .Slot Size Depth from <br /> Surface f YPe �Ilater al <br /> It Thickness 1]tameter`,. Type if Any Surface Fill Description <br /> FeeE to Feet inches Inches Inches Inches Feet to Feet ' <br /> h <br /> � S? <br /> Y <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 DTilfina..L'iP. „_ <br /> ❑Geophysical Log(s) Person,Firm or GorporaNgn <br /> 3632 O e Circle � Rancho Cordova PQ,.C95742 <br /> r- 13SoillWater Chemical Analyses A ;.; ciry State r <br /> El Other .Site Map Signed 08/01/2012 938110 P <br /> Attech additional Information If it ewsts. C•57 Licensed Water Well Con or Date Signed. C-57 License Number <br /> DWR 188 REV.U2OW IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />