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x, I <br /> " 'The free Adobe Reader may be used to view and complete*his form. However,software must.be purchased to complete,sa. , nd reuse a saved form. <br /> File Original with DWR State of California Mi <br /> Well Completion Report <br /> Page Of Refer tolnsfrucVonPamphlet State Well NumberlSlte Number-. <br /> Owner's Well Number MW-20 No. e0157772 I�-17 7 `1 <br /> Date Worts Began 07/26/2012 Date Work Ended 7/26/2012 Latitude I Longitude <br /> Local Permit Agency <br /> Permit Number 65313 Permit Date 7113/12 V APNfTRS/Other <br /> "i <br /> Orientation OVertical O Horizontal OAngle . Specify Name Ot m ian JV <br /> Drilling Method Auger Drilling Fluid Mailing Address 1300 Industrial Road#2 <br /> NO MN, <br /> a <br /> city San Carlos'[. State CA_Zip 95602 <br /> Overd rill to abandon 4"well to 35'and grout <br /> through AugersAddress 102Z ae Road <br /> City Ri t711 C San Joaquin _ <br /> Latitude gitu <br /> _ Dep. - Min. S .eq. Wn. ec <br /> Datum Revinnal t Decimal Lrong. <br /> APN Book P e arse <br /> Townshl 4-—Ra on <br /> NWeir <br /> I M11ficatiorVRepair <br /> O Deepen <br /> O Other <br /> • Destroy <br /> Describe procedures and materials <br /> rmder'GEOLOGIC LOG" <br /> F <br /> 7rt0h <br /> plY <br /> rte: <br /> ,..c [�Public❑IndustrialW <br /> Protection <br /> I O Dewatering <br /> - - O Heat Exchange - — <br /> ' Q Injection <br /> ARA. - O Monitoring <br /> O Remediation <br /> O Sparging <br /> ISO <br /> O Test Well <br /> r` Z.eete w deecrlbe dstance bfw ll from road.,buildings,fences, O Vapor Extraction <br /> &en,etc.and attach a map.�Uea eddGonsl paper Hneeecsary. O Other'_ PNaxe be eeeuram®rd c tete. <br /> y x'. <br />'I V1. Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (f=eet) Date Measured <br /> VTotalh ofng Fxet Estimated Yield* (GPM) Test Type <br /> ` Test Length (Hours) Total Drawdown (Feet). <br /> Total Depth Completed Well g �. Feet <br /> r *Ma not be re resentative of a well's ion term field. <br /> 1` <br /> Depth from hole t* pe k�W,4,- aterial watt Outside `Screen slot size Depth from <br /> Surface tbtaF : Thickness Diameter Type If Any Surface Fill Description <br /> +, <br /> Feet to Feet In s - Inches Inches Inches Feet to Feet <br /> ❑Geologic Log I,the undersigned,certify thatlthis report is complete and accurate to the best of my knowledge and belief <br /> ©Well Construction Diagram Name Cascade Drillina,L.P. _ <br /> ❑Geophysical L Person,Finn or Corporation <br /> Log(s) 3 2 Omec Circle Rancho Cordova CA 95742 <br /> 0 SoilNUater Chemical Analyses b d ss . city state ZJP <br /> I] Other Site Map Signed 08/01/2012 938110 <br /> Attach additional Inlomration If it exists. c-87 censedWater well Con6actDr Date Signed C-57 License Number <br /> DwR 188 REV.1r)0 IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> l <br />