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*The free Adobe Reader maybe used to view and complete#lis form. However,software must be purchased to complete,awnd reuse a saved form. <br /> File Originaf wfih DWR State of California 4 a <br /> Well Completioh Report <br /> Page of Rererto Instmcrlon Pamphlet <br /> State Weft NumbeASile Number <br /> Owner's well Number AS-1 No. e0157760 F I I I L I N w 1 <br /> Date work Began 07/24/2012 Date Work Ended 7/24/2012 Latitude Longitude <br /> Local Permit Agency San oagufn Qgunty Environmental Health <br /> Permit Number 65313 Permit Date 7113112 APNlTRS10ther <br /> Orientation OVertical O Horizontal OAngle Specify ; Name OI m lan'JV <br /> Drilling Method Au erDrilling Fluid Mailing Address 1300 Industrial Road#2 <br /> City San Carlos!i: State CA—Zi 95602 <br /> Overdrill to abandon 2"well to 33'and grout: Il <br /> through Augers ! Address 1022 Frbntacle Road <br /> City Rloon CM San Joaquin <br /> Latitude ngitu : <br /> Dea. Min, Shea. Min. <br /> Dalum Decimal L Decimalil ong. ' <br /> APN Book `` P a Parcel <br /> 15 I <br /> Township a Sdeion <br /> iswk .. <br /> s p <br /> - p N� ii well <br /> dh <br /> M0% <br /> o ification/Repair <br /> O Deepen <br /> O Other- <br /> Destroy <br /> therDestroy <br /> Oeanlbe ProceMree antl mehHele <br /> t - under-GEOLOGIC LOG' <br /> Q Water Supply <br /> .•: <br /> []Domestic []Public <br /> N m ❑tnigation ❑Industrial <br /> Lu <br /> • O Cathodic Protection <br /> " O Dewatering <br /> - ' „-. •.. II _ -O Heat Exchange%- -- , t= <br /> # TA O injection <br /> O Monitoring <br /> O Remediation <br /> , Y O Sparging <br /> t .. s <br /> ,South O Test Well <br /> �' ,Aslrate ar describe distance of we0 from roads,builanpa,lances, O Vapor Extractl0n <br /> My - - rivers,elo.and of sch a map.,;w�aditonal Paper it necessary. O Other <br /> an <br /> s' Please be nwrate d c fete. <br /> L. <br /> Tift <br /> r, Depth to first water (Feet below surface) <br /> ' Depth to Static <br /> Water Level (Feet) Dale Measured <br /> Total Depth of 13 rjng r:e. , .Feet Estimated Yield' (GPM) Test Type <br /> —77` 's7. Test Length (Hours) Total Drawdown (Feet) <br /> Total Depth o .Completed Well sy��" . Feet <br /> May not be re resentative of a well's long term yield. <br /> Depth from krshoieMateHal Wall Outside Screen Slat Size Depth from <br /> Surface t'Iisir Y.--,,,'Ty� ..f. _ Thickness Diameter Type `if Any Surface Fill Description <br /> Feel to Feet Inclie's :Sk• Inches Inches Inches Feet to Feet <br /> i;, Y• <br /> ❑Geologic Log I,the undersigned,certify that this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name Cascade Drilling.Lip. „„- <br /> Person,Firm or Corporation <br /> ❑ Geophysical Log(s) 3632 Omec Circle Rancho Cordga CA 95742 <br /> ❑ SoillWater Chemical Analyses Aare city state zip <br /> 0 Other Site Mau Signed 08/01/2012 938110 <br /> attach additional Information tt it wdsts. 7 Licensed water We antractor Date Si ned C-57 License Number <br /> DWR 188 REV.10" IF ADDITIONAL SPACE=IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br />