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5 + <br /> 'The free Adobe Reader may be used to view and oompler-`his form. However,software must be purchased to complete,sa ,and reuse a saved form. <br /> File Original with DWR Well Coam olet ifomia ��. � <br /> Page of p ion Report <br /> Refer to Mstructiorr Pamphlet State Well Number/Site Number <br /> Owner's Well Number MW-8 No. e0157765 N W <br /> Date Work Began 07/25/2012 Date Work Ended 7/25/2012 Latitude Longitude <br /> Local Permit Agency San Joaauln County Fnvlronmental Health <br /> Permit Number 65313 Permit bate 7113112' APN/TRS/Other <br /> Orientation O Vertical O Horizontal OAngle Specify <br /> Name O! m iari JV <br /> Drilling Method Auger Drilling Fluid Mailing Address 41300 Industrial Road#2 <br /> t E € I F Ci San Carlos State-C—A---Zip95602 <br /> Overdril.l to abandon 2"well to 30'and grout <br /> through Augers Address 10 Frontacie Road <br /> City Ripon C San Joaquin <br /> Latitude " gitude <br /> Nlii c. <br /> Datum Decimal L Decimal' ong. <br /> APN Book P e arcel <br /> Townshi a <br /> ' tion--- -�- <br /> r 3"s. 3s p N Well <br /> Mo ifcation/Repair <br /> O Deepen <br /> O Other <br /> x Destro <br /> Y <br /> _ Desaiba rocedu es e <br /> • -w:- nd materials <br /> p <br /> �^' under•oFwoi,oalc t.oc• <br /> O Water Supply <br /> Lrn <br /> omestic ❑Public <br /> i <br /> igation ❑industrial <br /> hodic Protection <br /> t b= ,i watering-,', <br /> 1 Y <br /> ;km at Exchange <br /> . ction <br /> #z ` <br /> nitoring�; mediationrgingSouth t Wellardesame dlsranee'd-11 from roads.bu ldinys,fenor Extractiondyers,etc.and attach a map:Use adAdonai paper N neceseaer <br /> i Please be acwrase and e <br /> s :.,<,, .. lets. <br /> Depth to first wafer (Feet below surface) <br /> Depth to Static <br /> "> yid" Water Level (Feet) Date Measured <br /> Total Depth of parlttig „. . Feef Estimated Yield` (GPM) Test Type <br /> Total Depth oPo ompleted Well res, Feet Test Length 1 (Hours) Total Drawdown (Feet) <br /> m_ Maynot be re re`sentative of a well's long term "eld. <br /> -H <br /> _. Depth from Of f 3`” w wall outside ``;+Screen slot size, Depth from <br /> pe Material <br /> Surfaces ' Thickness Diameter Type If Any j Surface Fill Description <br /> Feet to Feel Inc Inches Inches (inches)! Feet to Feet <br /> 1 <br /> Aft <br /> ❑ Geologic Log I,the undersigned,certify thafthis report is complete and accurate to the gest of my knowledge and belief <br /> ❑Well Construction Diagram Name Cascade Driliina,LIP. <br /> Person,Firm or Corporstlon <br /> r-3Geophysical Log(s) 632 Omec Circl Rancho Cordova CA 5742 <br /> ❑SoilNVater Chemical AnalysesAde City "— state zip <br /> El Other Site Mao _ Signed '. 08/01/2012 938110 <br /> 1 Anach additional hdormafir%r If it axials. C-57 Licensed Water) convector - Date Sinned C$7 License Number. <br /> DWR 188 REV.11200e IF ADDITIONAL SPACE 1$NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> 4E i. <br />