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*The free Adobe Reader may be used to view and comr ti this form. However,software must be purchased to complete,s•-- "end reuse a saved form. <br /> Fife Original with DWR State of Califorrila t <br /> Well Com p , <br /> Page � of 1s Completion Report <br /> - � � - <br /> Owner's Well Number MW-1 Rererto rosln�cflonPamphbr State Well Number/Site Number <br /> Date Work Began 04/09/2012 WD e015Q76f N W <br /> Date Work Ended - u <br /> Local Permit Agency Latkde Lon nude <br /> Permit Number 15502064 Permit Date 2/29/12 APN1r Jsro her <br /> Orientation O Vertical O Horizontal OAngle Specify <br /> Drilling Method Auger 7Nale ht Holdin s inc. <br /> Drilling Fluiddress 130 S.Wilson Wa0 kton l State CA �i :.a52050 60 :! <br /> verdrill 4 inch wells to 60 feet <br /> Address 130 Wilson Way Ntk <br /> City Si kton C San Joaquin ' <br /> Latitude ngitude. <br /> Dep. Min. scC4" ' ' - Min <br /> Datum Deeimal Lat r n Deama Ltong. a <br /> APN Book rP,p e_ � ""Parcel <br /> Towns in Rai on <br /> bra am,e Q NdW de . <br /> a w M Mo ifica•on/Repair <br /> O Deepen <br /> .may O Other <br /> n • 'Destroy <br /> Desorlbe.. under GEdv oGiC LOG'materires and als <br /> yk <br /> 41 O Water Supply <br /> z <br /> []Domestic ❑Public <br /> a rru ❑Irrigation ❑industrial <br /> ,n, <br /> ger <br /> O Cathodic Protection <br /> f' <br /> O Dewatering <br /> O Heal Exchange <br /> - Al <br /> O Injection' <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> ?7 <br /> South Test Well <br /> i'iuM`rateordeknbedistanoe'ofwell from roads,WWlntp,fences, O Vapor Extraction- <br /> krem etcend aftch a map use awnfonai paper Ir necessary Q Other <br /> �` ,7�.E� �}- Pkaea e9 xansla and corrr ata. <br /> . kw 1@ <br /> Depth to first water (Feet below surface) <br /> Ar Depth to Static <br /> Water Level (Feet) -Date Measured <br /> Total Depth of .,:' 0 fr'• <br /> p ��9 9 � 1., �. Feet Estimated Yield (GPM)(GPM) Test Type <br /> t ,, Test Length . (Hours) Total Drawdown (Feet) <br /> Total Depth o ornpleted Welt x;:. Feet <br /> *Ma not be re resentative of a well's long term yield. <br /> Depth from °;BoreholeTyl� Fater al wall Outside Screen Slot size Depth from. # <br /> Surface Daflete[ Thickness Diameter Type If Any Surface Fill Description <br /> Feet to Feet Inches' Inches inches Inches Feet to Feet <br /> �4 t <br /> ❑Geologic Lo 1,the undersigned,certify this re ort is cam late and 1 d <br /> og' g g fy p p accurate to the best of my knowledge and belief <br /> rson,Firm or <br /> ❑Well Construction Diagram Name Cascade Drillina.L.P. <br /> nifion <br /> ❑ Geophysical Log(s) 3032 Omec Circle Rancho Cordova CA 9574 <br /> ❑SoillWater Chemical Analyses Add•a City "'— stare zap i <br /> ❑Other Site Map Signed 4/26/2012 938110 <br /> Attach additional information it It exists, C-57 Licensed well Cont or Date SI ned C-57 LicenseNumber t <br /> ' <br /> a <br /> DWR 188 REV.102006 IF ADDITIONAL SPACE 1S NEEDED,US .NExT CONSECUTIVELY NUMBERED FORM - <br />