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1 IL <br /> N 'The Adobe Reader may be used to view and compietothis form. However,soRware must be purchased to mplete,sr ;and reuse a saved form. <br /> U J� State of California <br /> File ON nal with DWIR <br /> Well Completion Report !; <br /> Page of Rotor toIRSM 60nPampfr+ei State WellNumberlSReNumber <br /> Owners Well Number MW-6 No. e0148219 N w <br /> Date Wc rk Began,0210912012 Date Work Ended g=012 Latitude Lon ituae <br /> San �___..: r�....a.Cmeirnnmonfal Health <br /> Local P rmit Agency APNfTRSlOthar <br /> Permit umber 64191 Permit Date 1118112 ; <br /> Ori ntation O Vertical O Horizontal OAngle Specify Name Areadis <br /> Drilling Method Auger Drilling Fluid Mailing Address 950 Glenn Drive Suite 125 <br /> 11�'r ''` .'r Ci Folsomi l State CA Zi 95630 <br /> Pressure rout to abandon 85'wellggm <br /> ` <br /> Address . W } <br /> StOGkten i C <br /> San Joaquin <br /> City <br /> I ng . <br /> Latitude dudMin. S ^ <br /> Datum # D@umal Decimal•L`-ong ' <br /> APN Book Page _'Parcels 4 <br /> �T <br /> TownshipI�-<Ra S on <br /> 0 N' Well <br /> ,� �' ModificationlRepair <br /> {a 0 Deepen <br /> 0 Other <br /> Destroy <br /> Desalbe pracedlttea and me[Mals <br /> tu_ yam:' aader'GEOLOGIC LOG' <br /> p - 0 Water Supply <br /> ❑Dorrlestic ❑Public <br /> o ❑Irrigation ❑Industrial <br /> W <br /> O Cathodic Protection <br /> a• �1 O Dewatering <br /> • <br /> 7% <br /> O Heat Exchanger. <br /> *' O Injection <br /> 0 Monitoring <br /> O Remediation <br /> O Sparging <br /> South O Test Well <br /> r='yate ar deaafoe afatance ef.h from foam,bWldtnps,fences, 0 Vapor Extraction <br /> dvera,aft.and eHecti a map.Use eddwal O <br /> _ pepvlrneaeenary• Other <br /> 7�� �= ,- PNaaa M aenfrats 41d '. <br /> �> Depth to first,water (Feet below surface) <br /> � � Depth to Static <br /> <� :,`i �# (Feet) Date Measured <br /> Water Level <br /> Total D pth of Bot(ng , ` ,,.v Feet Estimated Yield` (GPM) Test Type <br /> Total pth of' otllpleted Well y Feet Test i.ength�� (Hours} Total Drawdown (Feet) <br /> -May not be re resentative of a well's long term yield. <br /> Deptfrom Borehole = vat@Wall Outside Screen Slot Slse <br /> Depth from <br /> Sur tice Dig Thickness Diameter Type if Any Surface Fill Description <br /> Feet. Feet Qn6lieiil Inches Inches Inches Feet to Feel <br /> k .i <br /> -;Ar <br /> J1W y. <br /> ❑ Biologic Log I,the undersigned,certify that this report is odmplete and accurate to the best of my knowledge and beliefM <br /> ❑ II Construction Diagram Name Drlllin L <br /> Person,Firm or Corporation <br /> ❑ eophysical Logs) 3 mec Circle i�ho Cordova CA 95742 <br /> ❑ oil/Water Chemical Analyses �67 <br /> city stare zip <br /> ❑+ ther Site Mao Signed 03/20/2012 938110 <br /> Aft add�onalinronrratiort xiteGdsts. �� m�TMaaa I# pate Signed G57 License Number <br /> k DWR 188 jEV.112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> 4 I <br />