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i14 <br /> 'The free Adobe Reader may be used to view and complef-"tis form. However,software must be purchased to complete,saves,and reuse a saved form. <br /> File Original with DWR State of Califomia n <br /> Page of Well Completion Report <br /> Rererto lnsmidionParnphlef Stele Well Number/Site Number <br /> Owner's Well Number MW-10 No. e0157745 <br /> N I I I I Iw <br /> Date Work Began 07/23/2012 -Date work 9 o Ended.7123/2012 7/2312 12 Latitude <br /> Longitude <br /> Local Permit Agency <br /> Permit Number 65313 Permit Date 7113/12 APNITRSlOther <br /> Orientation OVertical O Horizontal OAngle Specify----'.-' Name Oi m ian'JV <br /> Drilling Method Auaor Drilling Fluid, <br /> _ Mailing Address 1300 Industrial Road#2 <br /> city San CadosState CA Z, 95802 <br /> Overdrill to abandon 2e well to 36 and grout <br /> t) <br /> through Augers Address' 1022 FtQntaaa Road <br /> City Ripon San Joaquin <br /> Latitude gitud W <br /> Dep. Min, S - gyp. hl <br /> DatumDmaLeicl L Decimal421ong. <br /> APN Book P <br /> e Parcel <br /> II <br /> Township a $melon <br /> 1 <br /> � ificati <br /> N `w Well <br /> Mo onlRepair <br /> i O Deepen <br /> NYO Other <br /> a Destroy <br /> Oeaeribe procedures end matedala <br /> under`6EOLQQC LOW <br /> O Water Supply <br /> � []Domestic []Public <br /> cEJIrrigation ❑Industrial <br /> oz <br /> W <br /> p 0 Cathodic Protection <br /> ODe <br /> walering <br /> 411 <br /> + _ O Heat Exchange <br /> $, <br /> _ O injection <br /> `' 1',10 <br /> Monitoring <br /> „ Remediation <br /> 44 O Sparging <br /> .°gx "IL = South O Test Well <br /> . - '` a descne diotanma f well from roads,buildings,fences, <br /> O Vapor Extraction <br /> tPl.mz.bea"umtemd <br /> eta.and attach a map:;Llse addltloaal paper if necessary. O Other <br /> i late. <br /> _ r <br /> Depth to first water (Feet below surface) <br /> df Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of 0 ing ` ;., Feet Estimated Yield (GPM) Test Type <br /> 4 i Test Length (Hours) Total Drawdown (Feet) <br /> Total Depth oompleted Well * Feet <br /> u <br /> -may not be representative of a well's long term yield. <br /> Depth from hole ' t!4, —�°; Wall Outside Screen Slot Sized Depth from _ <br /> lrPe fdatarl`af <br /> Surface D1 #r 5 �w �, Thickness Diameter r Type If Any I Surface Fill Description <br /> Feet to Feet nates Inches Inches Inches feet to Feet <br /> s .p"¢e <br /> t Vii, <br /> 77 <br /> WIRM <br /> '. <br /> 13 Geologic Log 7am <br /> ndersigned,certify thatlthis report is complete and accurate to the gest of my knowledge and belief <br /> ❑Well Construction Diagram C�Spade dJrfina.L;P, <br /> ❑Geophysical L S Person,Firm orComoration <br /> yg ogO Omec Circl Rancho Cordova CA 95742 <br /> D SoilNVater Chemical Analyses A a s �� .--�� CIry state0 Other Site Map a n 08/01/2012 938110 <br /> Attach additional information If it e)dsts. C•57 Licensed Water911 Contractor Date Signed C-57 License Number <br /> DWR 188 REV.1@008 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> h, x <br /> ra ti. <br />