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'The free Adobe Reader may be used to view and completethisform. However,software must be purchased to complete, Wnd reuse a saved form. <br /> File Original with DWR Stale of California <br /> ' Page of <br /> Well Completion Report <br /> Owners Well Number MW-17 No. e0 5T7$9Refe, mphlet State Well NumberlSite Number <br /> [NJ I <br /> Date Work Began 07/26/2012 Date Work Ended 7/26/2012 Latitude Longitude—rn <br /> Local Permit Agency San Joaquin County Environmental Heath <br /> Permit Number 65313 Permit Date 7113/12 APNrrRS10ther <br /> x, s , <br /> -99L B.. <br /> Orientation O Vertical O Horizontal OAngle Specify Name Olympian`JV _ <br /> Drilling Method Auger Drilling Fluid <br /> Mailing Address 1300 Industrial Road#2 <br /> ' 7 1 Ci San Carlos State CA __Zip 95602 <br /> Overdrill to abandon 4-well to 35'and grout <br /> through Augers... Address 1022 Frontage Road <br /> City Ripon W San Joaquin <br /> Latitude rp. itud 1N <br /> D". Min. 5 Mih. Isec. <br /> DatumDecimal r Decima Ltong. <br /> APN Book P ge arael r«.. <br /> Townshipa on <br /> f0 O N Well <br /> h Ma Ification/Repair <br /> O Deepen <br /> 0 Other <br /> ' • Destroy <br /> Deac lbe procedures and mffWdnle <br /> under OFOLOGIC LRims <br /> OG' <br /> �� <br /> WE i <br /> Q Water Supply <br /> ❑Domestic ©Public <br /> ro m <br /> ❑lrrigatian ❑industrial <br /> x 0 Cathodic Protection <br /> �� O Dewatering <br /> • �' �_. <br /> - O Heat Exchange <br /> 0 injection <br /> 0 Monitoring <br /> �}z. <br /> � 0 Remediation <br /> ro'IF 0 Sparging <br /> South O Test Well <br /> ` N <br /> - - : Pkerras�e be accurate arM e . O Vapor Extractiondosabe Msaraelmmmrde'buim e' <br /> epndc 1ha pery. O <br /> Other <br /> y <br /> f <br />! - <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> M Water Level (Feel) Date Measured <br /> Total Depth of ding �� � `_� Feet Estimated Yield (GPM) Test Type <br /> Total Depth ofbCompleted Well �t F r ;. Feet Test Length (Hours) Total Drawdown (Feet) <br /> -May not be representative of a well's long term yield. <br /> &AIMMOWN AS <br /> -�Wlwm ROOM <br /> De fromhole wall Outside Screen M . <br /> aterlal ` of Siwe' Depth from <br /> Surface '��yype , Thickness Dlameter a If Any Surface Fill Description <br /> Feet to Feet Inti inches inches Inches Feet to Feet <br /> 1 J <br /> r I <br /> r I. <br /> yin.. <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 Drillin L'P <br /> Person,Firm or Corporation <br /> ❑Geophysical Log(s) 3632 Omee Circle Rancho Cordova CA 95742 <br /> ❑Soil/Water Chemical Analyses d s oty state zip �- <br /> ❑Other Site Map Signed08/01/2012 938110 <br /> Attach additional Infomtadon Oil exists. C-57 t.lcensea water e.il Convactor Dale Signed C-57 License Number <br /> DWR 188 REV.112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />