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`The free Adobe Reader may be used to view and eomple►F*his form. However,software must be purchased to complete,saw,and reuse a saved form. <br /> File Original with OWR - Stale of Califnmia <br /> Well Completion Report <br /> Page of Refer.I*Ins"ction Pamphlet State Well Number/Site Number <br /> F Owner's Well Number MW-13 No. eQ1577,57N w <br /> Date Work Began 07/26/2012 Date Worts Ended.7/2612012 latitude Longitude <br /> Local Permit Agency San Joaauin County Environmental Health <br /> Permit Number §5313 Permit Date 7113112 i[ s <br /> APN/TRS10ther <br /> - <br /> Orientation O Vertical O Horizontal OAngle Specify Name Olympialz JV <br /> DrillingMethut Auger Drilling Fluid Mailing Address ,1300 Industrial Road#2 <br /> do <br /> City San Caros' State_CA 95602 <br /> Overdrill to abandon 4e well to 35'and grout <br /> through Augers Address 1022 rrontaue Road Nbhr <br /> City Ripon ?g!, <br /> San Joaquin <br /> Latitude u <br /> Dog, Min. S pen. —KFh c <br /> Datum Q%;matL? Deedinnallong` <br /> APN Book R e arce <br /> Townshi s a on <br /> Y t <br />! ti. r Y, Q Neessnn��Well <br /> Molification/Repair <br /> O Deepen <br /> O Other <br />' • Destroy <br /> j r013De <br /> a procedures and matodals <br /> GEOLOGIC LOG' <br /> Supply <br /> .. <br /> estic ❑Public <br /> rnation ❑industrial <br /> dic Protection <br /> Ar n�nghangs <br /> AW 41, ' onoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> .�:+� a deacrme diatenoe of well from roads,bWldlnys,[enxa O Vapor EXtraction <br /> 3 _S .. riven,ek.and attach a map9 Use additional paper If neoes¢ary. O Other <br /> I <br /> hreaae bo acwraEe entic lore. <br /> Depth to first watei (Feet below surface) <br /> Depth to tic <br /> Water Level (Feet) Date Measured <br /> Tota!Depth of g Feet Estimated Wield GPM Test Type <br /> i r (GPM) yP <br /> Total Depth ompleted Well t : f Feet Test Length (Hours) Total Drawdown (Feel) <br /> aMa not be representative of a well's Ion term 'eld. <br /> -:` <br /> Depth from hole ater[al wall Outside q.Screen Slot Size Depth from <br /> a Surface r� Thickness Diameter Type If Any ; Surface Fill Description <br /> Feet to Feet fin i inches) (Inches Inches Feet to Feet <br /> a <br /> f <br /> ' .i <br /> 12 0 r <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 Drillina.L.P. _ <br /> Person,Firm orComoration <br /> 13 Geophysical Log(s) 3632 Omee Circle Rancho Cordova CA 95742 <br /> ❑ Soil/Water Chemical Analyses . Adores city state zip <br /> ❑Other Site Mao Signed 08/01/2012 938110 <br /> Anar:h ammonai information if it exists. -C-57 Licensed Water Weli Contractor Date Signed C-57 License Number <br /> DWR IBe REV,112006 IF ADDITIONAL SPACE IS NEEDED,LOSE NEXT CONSECUTIVELY NUMBERED FORM <br /> sR .. <br />