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"TheJ!Adobe Reader may be used to view and complete this form. However,software must be purchased to complete,58 ',and reuse a saved form.File l with DWR State of California 4 .� `Well Completion Report t <br /> Pagof ReWtofnsfruWOnPemphlet State Well NumberlSite Number <br /> .: Owner j Vell Number AS No. e014B212 :p N w <br /> Date W rk Began 02/07/2012 Date Work Ended <br /> Latitude Longitude <br /> Local P "d Agency r.__ r_,.,umn Cgunty Cn.dronmental Health APNI I KWOther <br /> Permit Iumber Permit Date 1118112 r , <br /> a. <br /> t3ri ntatlon Ida <br /> OVertical 0Horizontal OAngle SPe Name ArcadiS <br /> Drilting Method Augr Drilling Fluid Melling Address 950Glenn Drive Suite 125 <br /> Folsom' State CA 95630 <br /> Overdrill 20 well to 60'with S"Augers and arout <br /> Address 1612 W JJdirnmer LaDe <br /> City St kt}n J Cp . Y San.12nuln <br /> Latitude -98`771- <br /> �<4j, ngitud _W <br /> pep. Min. Sec 1 R Man *c. <br /> 'i i,�- Dec1ma,V0 ;v <br /> Datum Decimal Let t1: �•. <br /> APN Book I Page `Paroet = .. <br /> Townshi a -- <br /> . � 1111,11 1 M. m :q <br /> EMIR <br /> i - <br /> 1e 0 Ne nr Well <br /> R it <br /> Mo�'iticatlaN epa <br /> O Deepen <br /> 0 Other <br /> s Destroy. <br /> Ceaaiba d+oduree and mat"Wa <br /> undw'GEOLOGIC LOG' <br /> 0 Water Supply <br /> �y a M,.• ❑Domestic []Public <br /> m <br /> []irrigation ❑Industrial <br /> aax' 4 Fwd 0 Cathodic Protection <br /> x i0 Dewatering <br /> t <br /> f4, . 0 Heat Exchange <br /> Injection <br /> a. � 0 Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> �. <br /> ti y ii <br /> South 0 Test Well <br /> ,:e,� "eoe or dnaroe a>mnoe m well sa,n sada,bulfdhr�,,tencee: 0 Vapor Extraction <br /> Mere,aft.and aaach a map.UN adcHmad paper Kneaeeawy. 0 Other <br /> I ,.:. '�,�. i�,: Plmeba aeeunte ihd kte. <br /> i n k <br /> 7 Depth to first"water '{ (Feet below surface) <br /> $ ' Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total D ipth of Binge Feet Estimated Yield' (GPM) Test Type <br /> Tota!D'pth oi;ompleted Well Feet Test Length I; (Hours) Total Drawdown (Feet) <br /> `Ma not be re resentative of a well's long term field. <br /> —. <br /> Sur ee Ula' r l Materfal <br /> Thickness Outside <br /> r ST, slot Size <br /> Surface 1 <br /> De from Borehole teen Slot Slze Da from <br /> Feet Feat Inc '- * inches Inches Type Imes Fee! to Feel Description <br /> ❑ 'eologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑ Il Construction Diagram Name Cascade Drillin n i <br /> I <br /> ❑ eophysical Lag(S) nec Circle <br /> 2 Person, inn orCorporauan <br /> ❑ oitNVater Chemical Analyses R n h .IC r -- 95742 <br /> II . city state <br /> 0 er Site Map Signed 03/20/2012 39 8110 Zip <br /> Attech aft lorkel Mf mwfian If it exists. C-57 Licensed water contractor I] Date Signed C-57 License Number <br /> DNR t86 •12006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />