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h <br /> *The t Adobe Reader may be used to view and comple}4 this form. However,software must be purchased to Complete:s' and reuse a saved form. <br /> . � State ofCalifomia <br /> File Ori final with DWR <br /> Well Completion Report 10 <br /> Page of Refer to Ins"Wan Pamphlet state well Number/Site Number <br /> Owner' Well Number MW-12 No. ¢0148216 N w <br /> Date rk Began 02/09/2012 Date Work Ended 2/9/2012 _ ` Latitude LCn nude <br /> Local P nmit Agency n_._ 10an,,r.,n......•..CnlrimnrnenYal Health ApNfrR$lOther <br /> Permit umber-64190 Permit Date 1118112 <br /> Or rttatlon� OVertical O Horizontal OAngle Specify Name Arcadis <br /> Drilli fJkethod er Drilling Fluid Mailing Address 950 Glenn Drive Suite 125 <br /> C' Folsom' State Chi 95630 <br /> Overdrill 2"well to 42'with 8n Au ers&grout <br /> Address 1612WHaririmprL.ane " '- <br /> l. city S kt'n ° CW* San Joaquin <br /> Latitude °pgitude�;e. � <br /> Dec. Min. , , , '"QeP. min. ec. <br /> DeciT _Decimal hong <br /> Datum mal <br /> APN Book Page "'Parcef <br /> Townshlo Ra on <br /> O Nor Well <br /> MAficatioMRepair <br /> O Deepen <br /> Q Other <br /> u r rpt Destroy <br /> Dmatbe precedees and matul <br /> ynder'GEOLOGiC LOG' <br /> ne, <br /> " O Water Supply <br /> 4; ❑Domestic (]Public <br /> a &,� � � ❑Irrigation [Industrialr, w <br /> O Cathodic Protection <br /> Ir ' O Dewatering <br /> O Heat Exchange <br /> � .. 0 Injection <br /> O Monitoring <br /> _ T !j O Remediation <br /> O Sparging <br /> i O Test Well <br /> ;�,i�'Sa�vr South <br /> x< 'mss. .1lgntrate a daaama desance ar rao from mita.rnilanys.e.neea, O+ Vapor FJdr'action <br /> riven,etc.and elradi a map.Uee 0(00r.W paper ew HnM. 0 Other <br /> Ft.ha at .M' a left. <br /> Depth to firsl3water (Feet below surface <br /> �: Depth to Static <br /> r Water Level ' (Feet) Date Measured <br /> Total pth of Boringr k, Feet Estimated Yield' (GPM) Test Type <br /> Total Dpth efCompieted Well `. Feel Test Length (Hours) Total Drawdown (Feet) <br /> *May not be re resentative of a well's Ion term 'eid. <br /> De from T,Bomhole ` Wall Outside Screen Slot Size +Depth from _tom st�Td <br /> Su ce li'lrtr"Olype � INamrl Thickness Diameter Type HAn <br /> yp y { Surface Fill Description <br /> Feet Feet Incites ` "z n Inches Inches Indhes Feet to Feet <br /> w y <br /> ,14 NE. <br /> �w. <br /> i <br /> T <br /> ❑ logic Log I,the undersigned,certify that this report is ccimpiete^and accurate to the best of my knowledge and belief <br /> © II Construction Diagram Name Casosde Drilling.L.P. <br /> ❑ eophysicalLog(s)j Person,Firm or corporation jy 632 m fr ho Cordova _CA 95742 <br /> ❑ oil/Water Chemical Analyses Ae r Cny state Zip <br /> .❑ er Site Mat] Signed ;i 03/20/2012 938110 <br /> At�chadc onallMortrtadanirltexieffi. ce ieensadwarerwellCantraaw i y Date Signed C-57 License Number <br /> DM 188 EV.112006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM - <br /> .f <br /> 1 <br />