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.. 'The free Adobe Reader may be used to view and complete this form. However, software must be purchased to complete, save, and reuse a saved form. <br />File Original with DWR State of California <br />Well Completion Report <br />Page of Refer to nuo-admn Pamphlet <br />Owner's Well Number MW -5 No. e062861 <br />Date Work Began 02/2612007 Date Work Ended 2/26/2007 <br />Local Permit Agency San roantm. Cold ty <br />SR#49714 P 't Date 2/15/07 <br />DWR Use On —Do Not Pit In <br />I I I I I i <br />r�stale Weill Number/Site Number <br />11 I I 1 1 I'• L�LLL—Ly <br />Lot Lo hada <br />APN/rRS/Other <br />Permit Number erml a e <br />Orientation OVer ical 0 Horizontal OAngle Specify Name Arthur Lavacinino I <br />Drilling Method Hollow Stem Auger Drilling Fluid Mailing Address 1466 W Magill Ave <br />Depth from Surface Description Cit Fresno State CA Zip 93711 <br />Feet m Feet Describe material rain swe, color, etc I Y <br />Well Location <br />See Attached Address 47 East Alpine Ave <br />City Stockton County San Joaquin <br />Latitude N Longitude _Iry <br />Dec, Min. Si,, Dna Mm. Sa,. <br />Datum Decimal Lat. Decimal Long. <br />APN Book Page Parcel <br />Total Depth of Boring <br />Total Depth of Completed Well <br />3 <br />0.0 hon mzds, bulldnls braces. <br />use adddmnxl... e, aneces:Ery. <br />Depth to first water <br />Depth to Static <br />Water Level _ <br />Feet Estimated Yield' <br />Fsot Test Length <br />'Mav not be reores <br />0 Modification/Repair <br />O Deepen <br />0 Other <br />0 Destroy <br />under GEOLOGIC LOT <br />Planned Uses <br />0 Water Supply <br />[3 Domestic ❑Public <br />❑Irrigation ❑Industrial <br />0 Cathodic Protection <br />0 Dewatering <br />0 Heat Exchange <br />0 Injection <br />Monitoring <br />0 Remediation <br />0 Sparging <br />0 Test Well <br />0 Vapor Extraction <br />0 Other <br />(Feet below surface) <br />(Feet) Date Measured <br />(GPM) Test Type <br />(Hours) Total Drawdown (Feet) <br />I Depth from Borehole T Material wan Lmoeme ocree w..r u F.....-.. <br />Surface Diameter Type Thickness Diameter Type if Any Surface Fill Description <br />I] Geologic Log I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and bellet <br />I] Well Construction Diagram Name Cascade Drillinu, Inc <br />❑ Geophysical Log(s) 3632 <br />Person. F. CoryonR n ho ordova CA 95742 <br />❑ ft <br />SoigWater Chemical Analyses ,, SAW Lp <br />D Other Site Mal) Signed evV �Vl 10112/07 717510 <br />MR 188 REV. 12 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVE Y f EERFD FORM <br />