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-The AdoHader may be used to view and oomple+^this tome. However,software must be purchased to complete,s " %and reuse a saved form. <br /> State of California <br /> File Ori nalDWR f f] <br /> Well Completion Report ". <br /> Pe le< to Well Num <br /> beds <br /> 'Ite Number <br /> Page <br /> Of <br /> Relf3rfolnstrudlon mph 'i Std <br /> Ownel's Well Number MW-10 No. e0148224 " w <br /> Date Vvc rk Began 02/13/2012 Date Work Ended 2J1=012 I Latitude Longitude <br /> San <br /> �_.....,:.,n....nhr Fntrimnmantal Health ' <br /> Local P it Agency APNfrRSlptrler <br /> Permit Date <br /> Permit her 111$112 I <br /> RIO <br />{ orl ntatton OVertical O Horizontal OAngle Specify Name Arcadis <br /> Drilling hletlLod Au r Drilling Fluid mailing Address 950 Glenn Drive Suite 125 <br /> CltV Folsom l } StateCA _Zle 95630 <br /> Pressure arout to abandon 41.5'well <br /> Address _i < . <br /> City t ktonIy San Joaquin <br /> Latitude !' bngitud6"� <br /> pep. Min. SeCZ7"' 4, ,, w°hep. MhP SeC. <br /> Datum li Dimat L " * Decimal Long. <br /> APN Book Page F <br /> Township <br /> x <br /> Q NA*Weil <br /> I aRepair <br /> A 0 Deepen <br /> ax O Other <br /> g - Destroy <br /> D"edbe Oraeeduree and metedela <br /> under'GEOL.OGIC <br /> 0 Water Supply <br /> ❑Domestic ❑Public <br /> ❑irrigation ❑Industrial <br /> L0 <br /> Cathodic Protection <br /> Dewatering _ <br /> 0 Heat Exchange' <br /> Olnjection <br /> vi s 0 Monitoring <br /> �. ;3 ' 0 Remediation <br /> M. <br /> 0 Sparging <br /> i; south 0 Test Well <br /> � `•:�.. im�o-�o<adl>�e,�il'tremlOsa3.bulldbwys.,e„�, 0 Vapor Extraction <br /> river,,etc.aria m.a+a mea.rise a GMat paper it neeeaaary. 0 Other <br /> Please b..oeursm a nae kEo.l <br /> I <br /> .. o��: t 77.771 <br /> W"" � � Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level " (Feet) Date Measured <br /> Total Depth of Boig ., Feet Estimated Yield" (GPM) Test Type <br /> ' Test Length I�. (Hours) Total Drawdown (Feet) <br /> Total pth aCompleted Well 4 `'; Feet *May not be;presentative of a well's long term yjeld. <br /> Depti from ;imhole qPl' � wall outside screen stat size Depth from <br /> Sur lace t1FaYiter Thlckness Diameter Type If My 1 Surface Fill Description <br /> Feet Feet Ind4s Inches Inches Inches Feet to Feet <br /> ❑ eologic Log 1,the undersigned,certify that this report is complete and'aocurate to the best of my knowledge and belief <br /> 13II Construction Diagram Name Cascade Drlllina.L.P. + <br /> ❑ e0 h ical LO Person,Firm or Corporation <br /> } P ys Log(s) 3 Om Circle Aancho'Cordova CA 95742___. <br /> ❑ oil/Water Chemical Analyses t 'Adds f City state zip <br /> l 0 ther Site Man Signed 0 n a 4 ✓ 03/20/2012 938110 <br /> iAttach add oral Irlfonnalon If n eldsts. G57 uoa drew as I� Date Signed C-57 License Number <br /> DWR 1ee 1 tEV.972006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> J. <br />