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'The free Adobe Reader maybe 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 -1 <br />Date Work Began 02/21/2007 <br />Local Permit Agency San Joaouin Cold <br />Permit Number SR#49714 <br />State of California <br />Well Completion Report <br />Relerro lnawctbn Pempnder <br />No. e062834 <br />Date Work Ended 2/2112007 <br />Permit Date 2/15107 <br />DWR Use Only –Do Not FIII In <br />1 I <br />Stateto Well Number/Site Number <br />Lasntle Lo utle <br />I <br />APNmzsrotner <br />Geologic <br />Log <br />Well Owner <br />Orientation OVerical OHorizontal OAngle Specfry <br />Drilling Method Hollow Stem Auger Drilling Fluid <br />Name ArthurLavaonino <br />Mailing Address 1466 W Madill Ave <br />City Fresno Stale _CA_Zip 3711 <br />Depth from Surface Description <br />Feet m Feet Describe material grain 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 _ _ W <br />Den.MatSec. Den. Min. Sel,. <br />Datum Decimal Lat. Decimal Long. <br />APN Boi Page Parcel <br />Township —Range Section <br />Location Sketch <br />Sleetdh must be drawn h haM of erform isprinted) <br />Activit <br />Q. New Well <br />O Modification/Repair <br />O Deepen <br />O Other <br />O Destroy <br />Cassel ym edew and maemis <br />mdwr EotOGIctorr <br />North <br />lL <br />South <br />Planned Uses <br />O Water Supply <br />[]Domestic []Public <br />❑Irrigation ❑Industrial <br />O Cathodic Protection <br />O Dewatering <br />O Heat Exchange <br />O Injection <br />Q Monitoring <br />O Remediation <br />O Sparging <br />O Test Well <br />O Vapor Extraction <br />O Other <br />uwsessoreesenbe databaseof-41ban mads, badeaq, nenees. <br />ane.nam am.e us. -del-alvale, an—asm, <br />Please be accumbe and compiled, <br />[ter 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 />"Ma not be representative of a well's long term yield. <br />Total Depth of Boring <br />Total Depth of Completed Well <br />Feet <br />Feet <br />Ll <br />Casings <br />Annular Material <br />Depth from Borehole Type <br />Surface Diameter <br />Feet in 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 Feel <br />Attachments <br />Certification <br />Statement <br />❑� Geologic Log <br />❑' Well Construction Diagram <br />❑ Lo <br />Geophysical g(5) <br />❑ SoiVWater Chemical Analyses <br />❑� Other Site Map <br />Anacn aaad»nai irdormation xaee. <br />_ <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 />Parson. Famorcorpolatian <br />3632 ec CirCAc Cordova CA 95742 <br />cal' sae Zip <br />Signed �;10FLthi 10/12/07 717510 <br />, bcendd wader ex comraoor Date Signed C-57 License Number <br />DNR 188 REV. 12[06 IF ADDnIONAL SPACE IS NEEDED, USE NEXT CONSECUTIv V NU eERED FORM <br />