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'The free Adobe Reader may be used to view and c this form. However,software must be purchased to complf eve,and reuse a saved form. <br /> File Original with DWRState of California DWR Use Ont'-Do Not Fill In <br /> Page 1 of 1 Well Completion Report <br /> Refer tolnstructlon Pamphlet <br /> Owner's Well Number MW-2 No. e065582 State Well NumberlSite Number <br /> f Date Work Began 12/06/2007 Date Work Ended 12007 N w <br /> Latitude Lon nude <br /> Local Permit Agency San JQaoumn County <br /> Permit Number Permit Date L APNITRSIOther <br /> 'Geolo is Lo Well Owner. t1' <br /> Orientation OVertical 0Horizontal OAngle Specify Name RP/Arco <br /> Drilling Method Drilkirl Fluid ; <br /> Mailing Address 6 Center Point Drive <br /> ;Depth from Surface Description <br /> Feet .. to Feet <: La Palma State CA Zi 90623 <br /> Describe.material, rain size,color,etc Cit <br /> Neat cement to 3 feet I Well Location <br /> Mushroom cap grout seal to surface Address -85-F-ast Louise Avenue <br /> City LathropCol.San Joaquin <br /> Latitude N Longitude �N k <br /> Deo. Min, sec. i l Min. Sea rl <br /> Datum Decimal Lai. Decimal Long. <br /> APN Book Page Parcel <br /> ,Township Range Section <br /> Location Sketch 4k Activit <br /> Sketch must be drawn by hand afler form isprinted.) O New Well <br /> North 0 Modification/Repair <br /> O Deepen <br /> O Other <br /> Q Destroy <br /> describe Pio.<dures and materials <br /> under"GEOLOGICLOC' <br /> �-1 L-J L1 4# Planned Uses <br /> O Water Supply <br /> !I <br /> []Domestic ❑Public <br /> w <br /> El Irrigation [I Industrial <br /> O Cathodic Protection <br /> O Dewatering h <br /> .O Heat Exchange <br /> O Injection <br /> O Monitoring <br /> O Remediation <br /> ,< Q Sparging <br /> South Test Well <br /> O Vapor Extraction <br /> Illustrate.r describe diElante of wen from roads,buildings,fences, <br /> ra,etc,and acacfi a map,U..eddilional paper if necessary. O Other , <br /> Please be....rale and.om Plele, 7 <br /> aterlevel-and Yield of-Completed Well..: ' <br /> Depth to first water (Feet below surface) <br /> Depth to Static i <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring Feet Estimated Yield" (GPM) Test Type <br /> Depth ot,Completed Well Feet <br /> Test Length (Hours) Total Drawdown (Feet) <br /> Total <br /> *May not be representative of a well's long term yield. <br /> Casings: Annular Material .. .: <br /> Depth from Borehole _Type Material wall Outside Screen Slot Size Depth from <br /> " I <br /> Surface Diameter � Thickness Diameter Type If Any Surface Fill" Description <br /> —Feet to Feet Inches inches Inches Inches Feet to Feet <br /> 21—0 Cement Fill and seal boring <br /> is <br /> u <br /> Attachments. Certification Statement i <br /> ❑ Geologic Log 1,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑ Well Construction Diagram Name Collin Fischer with Stratus Env.. Inc.for Woodward Drillina <br /> Aerson,lor Corporation <br /> ❑ Geophysical Log(s) 3330 Cameron Park Drive suite 55C Cameron ParkCA_ 95682 I <br /> ❑ Soil/Water Chemical Analysesddress City State zip } <br /> F-1OtherSigned j 12/7/2007 71"0079 <br /> Attach additional information if it exists. - C-57 Licensed water well Contractor Date Signed C-57 License Number. <br /> DWR 188 REV.112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> I <br />