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*The fre Adobe Reader may be used to view and oomplet-+his form. However,software must be purchased to complete•s and reuse a saved form. <br /> File Ori nal with DWR State of California <br /> I Well Completion Report ;x <br /> I Page I -- Of RelbrtolnshicIfonPeMOW it State Well Number/Site Number <br /> 1 Owner's Well Number MW-11 N0. 90148222 N 'N <br /> Date Wc k Began 0211 312 01 2 Date Work Ended 2/13/2012 6' Latitude Lon nude <br /> i� <br /> Local PIE mit Agency APNlrR8101 <br /> Permit N imber 64190 Permit Date 1118112 �. <br /> Orf ntatlon O Vertical O Horizontal OAngle Specify Name Arcadi's <br /> Drilling Method Auger Drilling Fluid Mailing Address 950 Glenn Drive Suite 125 <br /> I Ww <br /> f'laee C Folsom,� 3 State Chi 95630 <br /> Pressure grout to abandon 41.5'well <br /> r71 <br /> Address 1612 W Hammer Lane _ . <br /> City SWktQh San Joaquin <br /> Latitude ngitu � �' <br /> Dep. Min Sec , Mtn <br /> Datum Decimal Lal DecimalA_Long. - y' <br /> APN Book Fapp„ a' i­'Parcet�, <br /> I <br /> TownshipII a " S.600n = <br /> 1 . N ,f Well <br /> l R <br /> Mo liificationlRepair <br /> Q Deepen <br /> O Other <br /> Destroy <br /> �" Deealbe Procedures and materials <br /> i mder'0E01.001C LOG' .V.. <br /> O Water Supply <br /> i ❑Domestic []Public <br /> a W ❑lmgalion []industrial <br /> ' w O Cathodic Protection <br /> O Dewatering. <br /> } <br /> 0 Heat Exchange <br /> IX7 Q Injection <br /> O Monitoring <br /> O Remediation <br /> Sparging <br /> South Test Well <br /> m. <br /> dfsmnce of mII 1r=roaft,bulldlnSp.fences, O Vapor Extraction <br /> Gunh a map.Use addrlanai Paper If necessary. Q Other <br /> PWaeMre�ratearide lat..p <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level 'r i (Feet) Date Measured <br /> Total D pth of ti Feel Estimated Yield' (GPM) Test Type <br /> 4 <br /> `. <br /> Test Length I? F (Hours) Total Drawdown (Feet) <br /> Total Depth o ompleted Well Feet *Ma not be re resentattve of a well's long term yield. <br /> 23o <br /> r <br /> H S'4V- tv�,s,77777,- <br /> Su ce I)iaftfeter YID <br /> De from 411 o�hale m 6ilaterls! Wall Outside Screen Slot Size. Depth from <br /> Thickness Diameter Type if Any } Surface Fill Description <br /> Feet Feet Ine k , Inches Inches Inches Feet to Feet <br /> I <br /> _ � .. 1, <br /> s- l <br /> 4` <br /> ❑ eologic Log 1,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑ ell Construction Diagram Name _Cascade Drilllna.L.P. <br /> I ❑Oeophysical Log(s) Person,Firm or Corporation :k <br /> Circle Rancho Corday. CA 95742 <br /> I ❑ oil/Water Chemical Analysesii city state ZIP <br /> ❑r er Site Map Signed re 03/20/2012 938110 <br /> Attach add onal Information rr M exists. C-57 Licensed water VM Contractor ri. '} Date Signed C-57 License Number <br /> {I DwR 188 EV.112DDB 1F ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> t <br /> i � '1 <br />