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'The free Adobe Reader may be used to vie <br /> w and com, this form. However,software must be purchased to complete,; and reuse a saved form, <br /> File Original with DWR <br /> State of California <br /> Page 5 of 18 <br /> Well Completion Report i <br /> Owner s Well Number MW 5 Refer to fnstnxvon Famphief <br /> No. e0150775 State well Number/Site Number <br /> Date Work Began 04/09/2012 Date Work Ended 419M 12 N Lw <br /> Local Permit Agency Latitude Lon 'tulle <br /> innirnental Health <br /> PermitDepartmenL- <br /> Number Permit Date 2129112 APNITRSIOther <br /> Orientation O Vertical O Horizontal OAngle Specify <br /> Drilling Method A erName Wi ht-Holdin-gs, Inc. <br /> Dolling Fluid <br /> allo ._ Mailing Address,130 S.Wilson way, <br /> D - ... . <br /> F C Stockton " State CA <br /> lo" 95205 <br /> 0 55 Ovt;rdrill 4 inch wells to 55 feet _ <br /> Address 130 S'Wil on W <br /> 'City Stockton Cty San Joaquin <br /> Latitude j. gltudeh <br /> 'Dep. - Min. Sec, �. mlit. ea <br /> Datum Dejcimal Lot a ' Det ima "ang._ <br /> APN Book P, e ` F'arceF, <br /> TownshipI' n <br /> an Z <br /> MNdW... Well,. <br /> Ooh ModificationfRepair <br /> ' `0 Deepen <br /> O Other- <br /> Destroy .. I <br /> Dewdbe Vr000chim and materfab <br /> F - under'GEOLOGlG LOG' <br /> O Water Supply <br /> n $ <br /> ❑a <br /> ❑ <br /> $ Domestic Public <br /> �. <br /> ❑!ni{fation ❑Industrial <br /> O Cathodic Protection <br /> O Dewatering <br /> r O Heat tacchange <br /> . , <br /> 0 injection <br /> "' s <br /> A�' '' -� � s O.Monitoring <br /> t O Remediation <br /> O Sparging <br /> '? s" South O Test Well <br /> deecn <br /> ee dstsnee 011 mom roads.nuudfnp,.*-M -0 Vapor Extraction <br /> i <br /> ase.etc.and attaoh a map Use addtlbnal paper N necessary. <br /> Pk—b.aeeuram and corn O Other <br /> r <br /> .' . <br /> b , - Depth to first water <br /> yDepth to Static <br /> (f=eet below surface) <br /> Y' Water Level. (Feeq Date Measured <br /> Total Depth of Bn'ng a �5 sffi , Feet Estimated Yield' (GPM) Test Type. <br /> Total Depth a om leted Well ' Test Length (Hours) Total Drawdown (Feet) <br /> R P -4 Feet *May not be re resentative of a well's Iona term yield. <br /> Depth from 7l3orehole YESr atel Wall Outside Screen slot Sirs Depth from <br /> Surface Di ate .a Thlekness Diameter Type If Any Surface Fill Description ' <br /> Feet to Feet Ince Inches Inches inches Feet to Fee! <br /> PVT' <br /> i <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 Drilli(ta.L.P. , <br /> ❑ Geophysical Log(s) Perm,Firm or corporation <br /> 3632 Om C'rcfe Rancho Cordova 95742.° <br /> '0 Soil/Water Chemical Analyses Add s City State z <br /> 0 Other Site M Signed 4/26/2012 93$11D p <br /> Attach additional Information if it exists. 7 Licensed raven c ctor - Date Signed C-5'7 License Number <br /> DWR 188 REV.12DDS IF ADDITIONAL SPACE IS NEEDED,USE.NEXT CONSECUTIVELY NUMBERED FORM I <br /> ' 7 <br /> h <br />