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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 <br />Page of <br />Owner's Well Number MW -4 <br />Date Work Began 02122(2007 <br />Local Permit Agency Ran Joanuin County <br />Permit Number SR#49714 <br />State of California <br />Well Completion Report <br />Rehr M Idshocr»n Pampeer <br />No. eO62860 <br />Date Work Ended =212007 <br />Permit Date 2115107 <br />DWR Use Only — Do Not Fill In <br />i <br />State Well NumberlSfte Number <br />Latitude Longitude <br />APN/TRS/Otner <br />Geologic <br />Log <br />Well Owner <br />Orientation OVertical O Horizontal OAngle Specify <br />Drilling Method Hollow Stem Au er Drilling Fluid <br />Name Arthur Lavagnino <br />Mailing Address 1466 W Magill Ave <br />Cit Fresno State Chi 93711 <br />Depth from Surface Description <br />Feel to Feet Describe material rain size color, etc <br />Well Location <br />See Attached <br />Address 47 East Aloine Ave <br />City Stockton County San Joaquin <br />Latitude N Longitude <br />Derr Min. Sec. Deg, Min. 5ec. <br />Datum Decimal Let. Decimal Long. <br />APN Book Page Parcel <br />Township -Range Section <br />Location Sketch <br />is iniad. <br />Activit <br />Sketch must De drawn by haM after fond <br />North <br />O New Well <br />O Modification/Repair <br />w " <br />3 w <br />South <br />O Deepen <br />O Other <br />O Destroy <br />Deserve prosodies and mel¢w: <br />Under GEOLOGIC LOG' <br />Planned Uses <br />O Water Supply <br />E3 Domestic ❑Public <br />❑Irrigation ❑Industrial <br />Q Cathodic Protection <br />O Dewatering <br />O Heat Exchange <br />O Injection <br />O Monitoring <br />Remediation <br />O Sparging <br />O Test Well <br />0 Vapor Extraction <br />Q Other <br />ended. erdeseaeasunce cdvadilran mad.. ewaiegs. ren. <br />rivers. em. and Mach a man. Use addhionai nac.. n n.asaanPS. <br />ba me a nn i.r.. <br />r and <br />WaterLeveland Yield of Completed Well <br />Depth to first water (Feet below surface) <br />Depth to Static <br />Water Level (Feet) Date Measured <br />Estimated Yield " (GPM) Test Type <br />Test Length (Hours) Total Drawdown _(Feet) <br />'Ma not be re resentative of a well's long term yield. <br />Total Depth of Boring <br />Total Depth of Completed Well <br />Feet <br />Feet <br />Casings <br />Annular Material <br />Depth from BoreholeWall <br />Surface Diameter Type <br />Feet to Feel Inches <br />Outside Screen Slot Size <br />Material Thickness Diameter Type if Any <br />Inches Inches Inches <br />Depth from <br />Surface Fill Description <br />Feet to Feet _ <br />Attachments <br />Certification <br />Statement <br />❑+ Geologic Log <br />❑+ Well Construction Diagram <br />❑ Geophysical Log(s) <br />❑ Soil/Water Chemical Analyses <br />Other Site Mao <br />Atmch addroorrel aformanon a n evs6 <br />I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief <br />Name Cascade Drilling Inc <br />Person Firm rpo n <br />3632 a irCl R n h ordova CA 95742 <br />Ad citySrac Zip <br />Signed 10112/07 717510 <br />1.wa&r n nvacmr Date Signed C-57 License Number <br />MR 18B REV ln" IF ADDRIONAL SPACE 15 NEEDED, USE NEXT CONSECJQVNUMBERED FORM <br />