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*The free Adobe Reader may be used to view and complete*his form. However,software must be purchased to complete,snd rause a sawed form. <br /> Fife Original with DWR State of California _nl ' . <br /> Well Completion Report <br /> ' Page Of Rererto tnswaionPamphlet State Well Number/Site Number <br /> Owner's Well Number MW-15 No. e0157764 NI I I I w <br /> Date Work Began 07/25/2012 Date Work Ended_7 2SWDJ2_ _; Latitude Longitude <br /> Local Permit Agency <br /> Permit Number 65313 Permit Date 7/13/12 ,+ APNrrRSIOther <br /> i JA <br /> Orientation O Vertical O Horizontal OAngle Specify Name OlVmpian'JV <br /> Drilling Method Auger Drilling FluidVa.1.1111's;1131111 cll:: Mailing Address 1300 Industrial Road#2 <br /> a C San Carios'� State Chi 95602 <br /> Overdrill to abandon 4'-well to 35'.and grout w <br /> through Augers Address 1022 Frontaae Road <br /> City Ripon San Joaquin <br /> Latitude gitu ytr <br /> Dep. Min. S <br /> Datum D cimal L Decima hong. <br /> APN Book �R a arcel <br /> Township r _Ra n <br /> r <br /> rte"' Repair <br /> Describe Procedures and msted4a <br /> ` under"6EOLOGlC LOG' <br /> i <br /> O Water Supply <br /> . ❑Domestic ❑Public <br /> M ❑Irrigation ❑industrial <br /> ` O Cathodic Protection <br /> O Dewatering <br /> O Heat l=xchange, <br /> O Injection <br /> w O Monitoring <br /> a <br /> t <br /> O Remediation <br /> .. O Sparging <br /> ..South <br /> O Test Well <br /> 9u'astate m deeadbe ,ca ef,een&M mads.bdidnps,fences O Vapor Extraction <br /> rivets,etc.and attach a map.`IUse additional paper If necessary. O Other <br /> kt<' Please be mwrata end comieft. <br /> r . <br /> e^a <br /> Depth to first watery (Feet below surface) <br /> Depth to Static <br /> Water Level - (Feet) Date Measured <br /> Total Depth of ng r. Feet Estimated Yield` (GPM) Test Type <br /> Total Depth ampleted Well +` a Feet Test Length (Hours) Total Drawdown (Feet) <br /> T. M2X not be re resentative of a well's long term yield. <br /> Y Depth from hole n star al wait Outside F;i Srreen 'slot size''! Depth From <br /> Ype �• <br />' Surface D -:,�� Thickness Diameter Type . if Any Surface FEtI Description <br /> Feet to Feet In Inches Inches inches Feet to Feet <br /> r <br /> ljv <br /> ❑Geologic Log 1,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name Cas de Drilling,L:P. <br /> Person,Firm or Corporation <br /> 0 Geophysical Log(s) 3632 Omec Circle -Rancho Cordova CA 95742 <br /> ❑ SoiVWater Chemical Analyses Address City state zip <br /> ElOther Site MaP igned 08/01/2012 938110 <br /> Attach additional information if it exists. C57 Licensed Water'WeIrIfforrITIFIhor Date Signed C-57 License Number <br /> DWR 188 REV.1!2006 IF ADDITIONAL SPACE IS NEEDED;USE NEXT CONSECUTIVELY NUMBERED FORM <br /> �F <br />