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I <br /> 'The free Adobe Reader may be used to view and complet, 'z form, However,saflwara_must be purchased to complete,.6,01-d reuse a saved fort. f <br /> File Original with DWR State of California s i 4rl <br /> Well Completion Report <br /> Page of Referto lns*n on Pamphlef State Well NumberlSRe Number <br /> Ownees Well Number EW-1 Na. e0157763 NI I I I Iw <br /> Date Work Began 07/25/2012 Date Work Ended 7/25/2012 Latitude Longitude <br /> Local Permit Agency San Joaauin County Environmental Health <br /> Permit Number 65313 Permit Dale 7113112 APNrrRSlother <br /> Orietit0on O Vertical O Horizontal OAngle Specify Name Olympian JV <br /> Drilling i4Aethod Auger Drilling Fluid Mailing Address 1300 Industrial Road#2 . <br /> 'i <br /> Ci San Carlos State CA--zip 95602 <br /> Overdrill to abandon 6"well to 36'Arid grout <br /> through Augers Address 1022 Firintacie Road <br /> City Ripon "°"' San Joaquin <br /> Latitude n stud <br /> Des. Min, sec '%iia. AWn. <br /> Datum cimal DecIrA' Lbng. .4 <br /> APN Book P e ff Parce . <br /> Townshi _ ekRa SAon <br /> � t_I <br /> s v Q N Well .. <br /> dh Mo 'ficationlRepair <br /> 0 Deepen <br /> • Destroy <br /> A ,t', Desatpe pracedrues end materials <br /> untler'GEOLOG11 LOG' <br /> Q Water Supply <br /> 3 ❑Domestic []Public <br /> ❑irrigation ❑Industrial <br /> Protection <br /> s:r <br /> "I 5 O Dewatering`n <br /> R t O Heat Exchange <br /> w,.. O Injection <br /> r <br /> ' O Monitoring <br /> r' O Remediation <br /> -� 0 Sparging <br /> u 0 Test Well <br /> 7�I or describe�etana of wes from roses.bulldinas.fences, O Vapor Extraction <br /> ihesa,etc.and Attach a map.Use additional paper If necessary. Q Other <br /> Please be aeeurats and a let". <br /> Y <br /> 1 � .. <br /> !Depth to first water <br /> (Feet below surface) <br /> s1 'Depth to Static <br /> Water Level (Feet) 'Date Measured <br /> Total Depth of.8dtrig ° deet Estimated Yield (GPM) Test Type <br /> a r (Feet?, Test Length (Hours) Total Drawdown <br /> 'total Depth of ompleted Well � Feet ¢ ) <br /> `Ma not be re Ere of a well. long term yield. . <br /> Depth from <br /> hole " Watt Outside Screen Slot Size l=: Depth from <br /> Surface Ape `r' b. i Thickness Diameter IT' Type NAny Surface Fill Description <br /> Feet to Feet Inds inches inches Inches Feet to Feet <br /> ❑Geologic Log I,the undersigned,certify that this report is complete:and accurate to the best of my knowledge and belief <br /> 13 Well Construction Diagram Name �SGede Drilling.L.P * , <br /> ❑Geophysical L Parson,Firm or Corporation <br /> Log(s) 632 O Circle Rancho Cordova CA 95742 <br /> ❑SOiUWater Chemical AnalysesAd re .. City state Zip <br /> tD Other it ned <br /> Sig08161/20i2 ,938110 <br /> Atlach addWohal information frit exists. C57 Ucafts&l water wen Contractor Date Signed C-57 License Number <br /> DWR 188 REV.112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> z <br />