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"The Free Adobe Reader may be used to view and com- 'his form. However,software must be purchased to complete,f' brad reuse a saved form; <br /> File Original with DWR State of California <br /> Page 11 of 18 Well Completion Report <br /> Owners Well Number MW-11 Rererfe011 0781aon mphlef State well Nu''I Number <br /> Date Work Began 04/11/2012 No. e01160781 � w <br /> g Date Work Ended Latitude Longitude <br /> Local Permit Agency Sgn j0aguin C <br /> Permit Number 15502064 Permit Date 2129112 Ai WTRsrother <br /> Orientation O Vertical O Horizontal OArtgle Specify Name-Wi ht Holdings, Ino. <br /> Drilling Method Au er Drilling Fluid <br /> � ► f. <br /> Ma'I ddress t ing A 130 S.Wilson Way _ <br /> Cit Stockton " CA <br /> - " State, io 95205 i3 <br /> 0 55 Overdrill 4 inch well to 55 feet. ' <br /> Address 0 S' ilson Wa ��'� •• <br /> . City Stockton � C6aa� San Joaqutr � ._ <br /> . Latitude „_�,� ongdud r*"�, w <br /> - <br /> Datum Decimal Laid . Decfma ong. <br /> APN Book' y'"Pquge me Par oef 'm <br /> -Ran SQAion A <br /> Township I <br /> Qllh0 N Well <br /> 0 Moification/Repair <br /> x <br /> �,. � ' O Deepen <br /> O Other_ <br /> Destroy <br /> DeacUnderl'G prarOGIC s and matrxlab <br /> u�p'GEOLOGIC L06' <br /> O"WaterSupply .. <br /> Domestic P <br /> as krr ❑ ❑ ublic <br /> C ,.2 D Irrigation ❑Industrial <br /> . 0 Cathodic Protection <br /> a' 0 Dewatering I <br /> 0 Heat 6cchange <br /> 0 Injection <br /> T <br /> 0 Monitoring <br /> 0 Remediation <br /> 0 Test Well j <br /> South building%fe of O Vapor Factradion ` <br /> 'Irtwate m tlnMbe distance Snell from matla x, <br /> rhror%etc arid attach a map Use additional parer If necessary. O Cither <br /> F <br /> r R Ptoses be-aft and eb111 <br /> '= Depth to first water (Feet below surface) L <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth oZillc <br /> M g y %Feet Estimated Yield a (GPM) Test Type <br /> *a .. Test Length (Hours)Total Drawdown <br /> Total Depth om (Feet) <br /> pleted Well f z� Feet <br /> Way not be re resentative of a well's Iona teen vield. <br /> Depth from ''borehole Nabr i Wall Outside Screen Slot Size. Depth from <br /> Surface Dll is r - Thickness Diameter Type If Any Surface Fill Description <br /> Feet to Feet Inc es '' Inches inches Inches Feet to Feet <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 Cascade Drilling.L.P. <br /> ❑Geophysical Log(s) Person,Firm or Corporation <br /> 3632 Ornec Circle- Rancho Cordova CA 95742__ <br /> ❑SoillWaler Chemical Analyses dare city -- state ZIP- <br /> El <br /> Jp <br /> ❑+ Other Site MaD Signed 4/26/2012 938110 <br /> Attars,alcilbonat infonnaticn It it eAsta. c-57 uoensed water Aell Co rdor. Date Signed C-57 License Number <br /> DWR 188 REV.112003 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />