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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 O( <br />Owner's Well Number MW -3 <br />Date Work Began 02/22/2007 <br />Local Permit Agency San Joauuin County <br />Permit Number SR#49714 <br />State of California <br />Well Completion Report <br />Rated lan Pemnnter <br />No. ¢0628O62859 <br />Date Work Ended 2/22/2007 <br />Permit Date 2/15/07 <br />DWR Use Only -Do Not FlII In <br />7777- <br />I I t <br />State Well Number5rie Number <br />t aHRude Lo <br />F7 I I i i I I <br />ARNITRS/Other <br />Geologic <br />Log <br />Well Owner <br />Orientation OVertical O Horizontal OAngle Specify <br />Drilling Method Hollow Siem Au ter Drilhng Fluitl <br />Name Arthur Lavaonino <br />Mailing Address 1466 W Magill Ave <br />CitFresno State­CA_Zip 93711 <br />Depth from Surface Description <br />Feet to Feet Describe material drain size color. etc <br />Well Location <br />See Attached <br />Address 47 East Alpine Ave <br />City Stockton County San Joaquin <br />Latitude N Longitude <br />Dep. MinSec. Dep. Min. Sec. <br />Datum Decimal tat. Decimal Long. <br />APN Book Page Parcel <br />Township _Range Section <br />Location Sketch <br />Activit <br />Sketch must tre dram by harp atter form Is rimed. <br />North <br />O New Well <br />0 Modification/Repair <br />0 Deepen <br />0 Other <br />0 Destroy <br />o.amh.I cedure. and marenal. <br />under GEOIOOiC LOCM <br />3 ui <br />South <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 />G) Monitoring <br />0 Remediation <br />0 Sparging <br />0 Test Well <br />0 Vapor Extraction <br />0 Other <br />IIN.baeprdesenhe oral.nee Mien porn read, bmunpa. renal. <br />i.a, ore. and anacn a man. use ands enm paper d necessaw. <br />deas be a..araae Mn am ieN <br />Water Level and 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 />'May 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 Borehole Type <br />Surface Diameter <br />Feel to Feet Inches <br />Material Wall Outside Screen Slot Size <br />Thickness Diameter Type If Any <br />Inches Inches Inches <br />Depth from <br />Surface Fill Description <br />Feet to Feet <br />Attachments <br />Certification Statement <br />❑' Geologic Log <br />❑� Well Construction Diagram <br />❑ Lo (s <br />Geophysical 9 ) <br />❑ Sotl/Water Chemical Analyses <br />❑O Other Site Map <br />nttacnaadmrreurnmmaapn rcrceasa <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 Fran or Coaporawn <br />3632 O . Girt a ncho Cordova CA 95742 <br />Ad nn pp ,^, c Sal zip <br />.. <br />Signed V`' -QAA 10/12/07 717510 <br />c peardeskinsiterWbil conoscmr Date Signed C-57 License Number <br />MR 188 REV 1rz IF ADDITIONAL SPACE IS NEEDED, USE NE CONSECUTIVE7 <br />MBERED FORM <br />