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li <br /> . •The frLAd:obeader may be usedto view and comple'-'his form. However,software must be purchased to complete,v' ;and reuse a saved form. <br /> File ODWR State of CaliforniaWell Completion Report <br /> PageOf Refer to Instrucdfon Pamphw state Well Number/Site Number <br /> Owners el!Number VW-4 No. e0148223 N W <br /> Date W began 02/13/2012 Date Work Ended 3 Latitude Lon nude <br /> Local Permit Agency &J"" l""""l"COun v Fgyironmentall Health h APN/TRS/t]Uler <br /> Permit Number 64190 Permit Date 1118112 K <br /> O ntation O Vertical O Horizontal OAngle Specify Name Arcad'i§ I <br /> Drilling Method A er Drilling Fluid Mailing Address 950 Glenn Drive Shite 125 <br /> Cit, Folsom l 1 State CA i 95630 <br /> Pressure c <br /> irout to abandon 46,5'well .-. <br /> Address 1612 W H comer Lan Y <br /> City Stockt66San Joaquin <br /> Latitude li � �gdud �� _ -_yy <br /> c%. Mtn: Sec Mm Sec <br /> Datum ij Decimal t l� DecimahLong <br /> g <br /> APN Book p e arcelC� <br /> Townsh! I �;Ra on - <br /> Q NdW Well <br /> Q McdiiificationlRepair <br /> Q Deepen <br /> r 0 Other <br /> Destroy <br /> DesaAbe ppiocedu end rnAtm is <br /> i - under'GEOLOGIC LOG' <br /> Q Water Supply <br /> []Domestic ❑Public <br /> t F „` o ❑Irrigation ❑Industrial <br /> 0 Cathodic Protection <br /> d L . e O Dewatering <br /> • ,- Q Heat Exchange' �r- <br /> r,. <br /> .r 3' 0 Injection <br /> 0Monitorin <br /> 9 <br /> •.Wij1l AS!. 1. <br /> i 0 Remediation ! <br /> 0 Sparging I <br /> south 0 Test Well <br /> di.ra,oa stxell'6orn meds.bulldogs,fences, O Vapor Extraction <br /> a overs,etc.end awash a map.Use additlMal paper H neceaeery. 0 Other <br /> s�}"+�, }.. Plena W acaura[:aid a Me.1 <br /> `f <br /> Depth to first water ;i (Feet below surface) <br /> Depth to Static <br /> K Y Water Leel - (Feet) Date Measured <br /> Total pth of Boffig _ ,._,_beet Estimated Yield` (GPM) Test Type <br /> Total pth oCompleted Well y >. Feet Test Length li (Hours) Total Drawdown (Feet) <br /> -may not be representative of a well's IoQg term yield. <br /> -,hSL`i,;. r .. ,e.•�,1.., .a.. ry.w.<.. .� „; - •€ st .f �x idly <br /> � De from -,VmholeWall Outside Screen Slat Sire Depth from <br /> SuisceDIMItYPeh1�Aatarlal Thickness Diameter Type If Any j Surface Fill Description <br /> Feet Feet Ind "' Inches Inches Inclies Feet to Feet <br /> 11 1 <br /> ' ❑ eol is L 1,the undersigned,cern that this s w n <br /> Ij og Log is report is complete and accurate to the best of my knowledge and belief <br /> © el!Construction Diagram Name D ilii L.P. <br /> h L Person,Firm or corporation <br /> 13eo 1Cal M <br /> P lis Log(s) 2 m Circle Rancho Cordova CA 9§742 <br /> ❑ oil/Water Chemical Analyses y city state Zip <br /> D r Site Map Signed J .,� 03/20/2012 938110 <br /> Attach additional information If R exists. 11 C-57 Licensed water well ConbreGor y t Date Signed C-57 License Number <br /> DWR 188 1 tEV.112DDS IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />