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'The free Adobe Reader may be used to view and complef-'his form. However,software must be purchased to complete.11MAnd reuse a saved form, <br /> File Original with DWIR State of Calif6mia 1 <br /> Pae of Well Completion Report <br /> Page Rererro Jnatrucfion Pamphlet State Well Number/Site Number <br /> Owner's Well Number MW-9 No. e0157762 N W <br />` Date Work Began 07/25/2012 Date Work Ended°7/25/2012 <br /> .,, Latitude Lon dude <br /> r Local Permit Agency San Joaauln County Environme=1Health , <br /> Permit Number 65313 Permit Date 7/13/12 l APNITRS/Other <br /> I <br /> i <br /> Orlentatlon OVerfica! O Horizontal OAngle specify Name OI m iari JV <br /> Drilling Method Auger Drilling Fluid <br /> Mailing Address 9300 Industrial Road#2 <br /> :+ e t , City San Carlos CA 95602State t <br /> Overdrill to abandon 2"well to 30'and grout :s H <br /> t through Augers Address 2 ronta e <br /> city Rion f San Joaquin <br /> Latitude . 1 gitu _fro <br /> Dep. Min. Sec p. Sec. <br /> Datum Dei imal L Decim ng. <br /> APN Book P e rFaroell <br /> Townshipa n <br /> i <br /> O Mo�diflc N "w Wel . <br /> il"VRepair <br /> O Deepen <br /> r' O Other <br /> Q Destroy <br /> under Gscribe EOLOGIC LOG"rocedures and materiels <br /> O Water Supply <br /> ❑Domestic ❑Public <br /> Ij m w [Irrigation [Industrial <br /> O Cathodic Protection <br /> a y O Dewatering <br /> O Heat Exchange <br /> k0Injection <br /> A " O Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> uuatrate w desaida Astence'a!rre9 from roads.6ulfdf�ps.rencea, O Vapor Extraction <br /> and attacksa mep;�Uee ad�tlonel paper Ifnees".y. O Other <br /> Please be wwrate and c <br /> Depth to first water <br /> Depth to Static (Feet below surface) <br /> ' <br /> Water Level (Feet) Date Measured <br /> Total Depth Zo-mipleted <br /> �'g 11 <br /> Estimated Yield" (GPM) Test Type <br /> epthTest Length (Hours) Total Drawdown (Feet) <br /> Total DWell ��, .� Feet � <br /> "Ma not be re resentative of a well's long term yield. <br /> ,- � �... . 12202 MR-0��a <br /> Depth from Bthole m�^�Ypa ..zmal Wall Outside Screen slotsizel Depth from <br /> Surface Differ';.r Thickness Diameter Type if Any Surface Fill Description <br /> Feet to Feet inc if3s Inches inches Inches Feet to Feet <br /> i,s - <br /> _ g . <br /> 0 Geologic Log <br /> 7,9g <br /> undersigned,certify that;this report is complete and accurate to the best of my knowledge and belief_ <br /> ❑Well Construction Diagram ..Cascade Drilling.Lf. <br /> Person,Finn.or Corporation <br /> ❑Geophysical Log(s) 2 mec Circle ARancho Cordova GA 95742 <br /> Cl SolIANater Chemical Analyses A s city state Zip <br /> D+ Other Site MaD d 08/01/2012 938110 <br /> Attach add!Uonat information If it wrists. .-C-67 cen"d Waffr-WeTContractor - Date Signed C-57 License Number <br /> DWR 188 REV,1/2006 IF ADDITIONAL SPACE IS NEEDED;USE NEXT CONSECUTIVELY NUMBERED FORM <br /> uj;rt <br />