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;i <br /> -The f Adobe Reader may be used to view and compi�is form. However,aafiware must be purchased to complete,} and reuse a saved form. <br /> File Ori nal with DWR State of California { <br /> Well Completion Report <br />{ Page of RerertornstrudlonPamphWf State WellNumbedsiteNumber W <br /> 1 Owners Well Number MW-7 No. e011482118 N <br /> 91QI9f112 Latitude t_on nude <br /> Date W rk Began 02/09/2012 Date Work Ended I HealthI <br /> Local P Rn$Agency APNITRSIOther <br /> Permit Number 64191 Permit Date 111$112 <br /> ON rrtatlan O Verticaf O Horizontal OAngle Specify Name Arcadis <br /> Dr;rring Method A er Drilling Fluid Mailing Address 950 Glenn Drive Suite 125 <br /> Folsom <br /> F State Ch95630 <br /> City Folsom <br /> .�.�� <br /> Pressure rout to abandon 41'well <br /> Address 161 2 W Liarrimer e ` <br /> City Stockton C1ty San Joaquin <br /> Latitudeyangttud <br /> Dep. Min. Sec. -$Dep. Mm. Sea <br /> Datum mal L ' .Decimal ng <br /> APN Book it Page 1 Sarcet _ <br /> TownshipRa <br /> �. <br /> N&Well <br /> Q M41fication/Repair <br /> r; d 0 Deepen <br /> 0 Other <br /> Destroy <br /> Descrbe p and mehntala <br /> mrd«•GEOLOGIC LOG' <br /> a ,3 <br /> Q Water Supply <br /> ❑domestic []Public❑Irrigation []Industrial <br /> w <br /> Protection <br /> � � Cathodic Pro <br /> O Dewatering <br /> �.- O Heat Exchange <br /> 0 Injection <br /> O Monitoring <br /> O Remediation <br /> O Sparging <br /> � + O Test Well <br /> «eeamna'aanm�aervw rflt nme&,eua�a,fena' 0 Vapor Extraction <br /> it eM.W.and aeerh a map.Use edmonal paper n nece M. O Other <br /> --- {x PWas 6r aeena4 indc IeOe. .y <br /> Depth to first water (Feet below surface) <br /> " _4 Depth to Static <br /> Water Level i (Feet) Date Measured <br /> Total D?pth of Bixing IL � 1.�. ` Feet Estimated Yield" (GPM) Test Type <br /> Test Length 1 (Hours) Total Drawdown (Feet) <br /> Total D pth 4-Completed Well w 6 Feet <br /> LMay not be're resentative of a well's long term yield. <br /> 5:kar 'Yr's'� o°'4,x E ✓"`_::, g' i:;r �; ';,:," �ry" 7 !PP <br /> De from t�ggrshotek % tiAaterlal wall Outside Screen slot Size .M Depth from <br /> Su ce Diameter '' y Thickness Diameter Type if3Any Surface FIII DescriptionT <br /> Feet I D Feet Inches inches inches Inches Feet to Feet <br /> I, <br /> {P <br /> i <br /> . .. <br /> M <br /> I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> tion Diagram Name Cascade Drilling.L.P. it .. <br /> Log(s) Person,Firm orCorpomuon i' I <br /> 3 2 e Circle Rancho Cordova CA 94742 <br /> Chem Analyses s city scare zip <br /> ao Sig 03/20/2012 93$110 <br /> Attach add Jwel inrormetion If it exists. C-67 Licensed W;ftPVVqII Contrador If Date Signed C-57 License Number <br /> DWR 188 1 tEV V2006 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />