Laserfiche WebLink
'The free Adobe Reader may be used to view and eompletr''his fort. However,software must be purchased to complete,saland reuse a saved form. <br /> File Original with DWR State of California <br /> Well Completion Report Page of Refer Io lnsfrucrion.Nmphlet State Well NumbedSile Number <br /> Owner's Well Number MW-19 NO- 01577711- -1 . I I I IE w <br /> Dale Work Began 07/26/2012 Dale Work Ended 7/26/2012 atitude Longitude <br /> Local Permit Agency San Joaauin County Environmental Health <br /> Permit Number 65313 Permit Date 7/13/12 APNfrRSlQther <br /> Orientation OYertical 0Horizontal OAngle SpecifyName Olymoian,W <br /> -- - <br /> Drilling Method LNer Drilling Fluid Mailing Address 1300 Industrial Road#2 . <br /> d" ! <br /> City.San Carlosf State CA___zip 95602 <br /> Overdrill to abandon 4"well to Wand grout ! a <br /> through Augers Address I EeontgggRoad NL <br /> City Ripon C San J . <br /> Joaquin <br /> Latitude L glia <br /> Dep. " - Mtn. Seo. <br /> Datum ;Decimal L Decima tong. ,# <br /> r I APN Book Pae Par <br /> i <br /> Townshi i sAin. <br /> n aft nte. <br /> w. <br /> Q N eN <br /> 'rih M - W Ification/Repair <br /> O Deepen <br /> O Other <br /> • Destroy <br /> Dwedbe pmcedures and materinle <br /> under'GEOLOGIC LOG' <br /> .. ..< R _ <br /> W60 <br /> Q Water Supply <br /> s� � � apply <br /> i ❑Domestic ❑Public <br /> ,e..„ w ❑Irrigation ❑industrial <br /> Or <br /> O Cathodic Protection <br /> i. O Dewatering <br /> O Heat Exchange - <br /> "` " 0Injection <br /> rNh. __i O Monitoring <br /> O Remediation <br /> O Sparging <br /> h. <br /> Sisouth Q Test Well <br /> I"avaor or descrihe dtetancerofwell from road®,hraldnge,fencee, O Vapor Extraction <br /> Irlvem,W.end eftoh a meddl8nnal paper if neeeeeery. O Other <br /> Pkaae to maurate and c= <br /> i <br /> .. De th to first water <br /> P (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of .1' ^g Feet Estimated Yield' (GPM) Test Type <br /> Total Depth c ompleted Well � Feet <br /> Test Length (Hours) Total Drawdown (Feet) <br /> *May not be representative of a well's long term yield. <br /> RAr <br /> Depth from hole ��hllaterlal Wall Outside ' Screen SEot 81ze Depth from <br /> Surface Cit e <br /> �Y - Thickness Diameter Type If Any i! Surface Fill Description <br /> Feet to Feet Inc a "` inches Inches) (inches) Feet to Feet <br /> i <br /> r. <br /> ❑Geologic Log I,the undersigned,certify th&this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name Cascade Drilling,L l:-. <br /> Person,Firm or Corporeton©Ge0 hYsfC81 Log(s) 3632 Ome Circle <br /> Rancho Cordova CA 95742 <br /> 0 SOlIlWaler Chemical Analyses A - city state Zip <br /> El Other Site Map Signed 08/01/2012 938110 <br /> Attach additional infor n rtlon If it exists. 470censedWakerVid. lConsrsclor Date Signed C-57 License Number <br />' DWR 188 REV.l 2" IF ADDITIONAL SPACE Is NEEDED.USE NEXT CONSECUTIVELY NUMBERED FORM - <br /> t� <br />