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*The free Adobe Reader may be used to view and compf....,cs form. However,software must be purchased to Complete,s,_fend reuse a saved form, <br /> File Original with DWR State of California DWR I------ <br /> Page 14 of 17 Well Completion Report <br /> Owners Well Number OW-7 Refer to Instniction parnphtql <br /> ' <br /> NO- 01152708 State Well Number/Site Number = <br /> Date Work Began 05/14/2012 Date Work Ended N <br /> Local Permit Agen <br /> cy-.Qan Jg <br /> Permit Number-NA Permit Date 5/8/12 <br /> g APIS11TRS/Crthilt, <br /> Geolo is LoWeH <br /> Orientation CO Vertical Horizontal UARgle Specify writer <br /> Drilling Method Hollow Stem Auger Drilling Fluid Bentonite mud Name Farms <br /> M <br /> Depth from Surface Description ailing Address 2460 Trse,f-0-4 <br /> 16 Feet to 0 Feet Describe material,grain size,color,etc C! y <br /> Qverdrill r— — state_CA__Zip 953772 <br /> ng all well materials, <br /> Weil Location <br /> A:Idress <br /> City T. racy County <br /> U titude N Longitude_ <br /> De7 min, sec, <br /> Datum_Decimal Lat. Dec. min. Sec, <br /> Decimal Long. <br /> Ai Book IN Page P <br /> Parcel 25 <br /> T"wriship —Range Section Section <br /> Location Sketch Activity <br /> ,Sketch must be drawny hand after to"is anted. <br /> North C)New Well <br /> 0 Modification/Repair <br /> 0 Deepen <br /> 0 Other <br /> @ Destroy <br /> Ireacnbe prwedum and matefoh, <br /> wderGEOLOGIC LOW <br /> Planned Uses <br /> 0 Water Supply <br /> Se C�iq <br /> E]Domestic []Public <br /> Oirrigation Elindustrial <br /> 0 Cathodic Protection <br /> 0 Dewatering <br /> 0 Heat Exchange <br /> 0 Injection <br /> 0 Monitoring <br /> 0 Remediation <br /> 0 Sparging <br /> South 9 Test Well <br /> HiLmiate or describe distance of"a tromroads,bodings,lances- 0 Vapor Extraction <br /> riven,etc:and attach a map.u" ftrioner paper 11 aaricastrory, 0 Other Ozgne <br /> Pkaiebaaacuraee and tett; <br /> Willer Level and Tlelcl of completed Well <br /> Depth to first water <br /> Depth to Static (Feet below surface) <br /> Witter Level (Feet) Date Measured <br /> Total Depth of Boring 16 Feet Es':imated Yield (GPM) Test Type <br /> Total Depth of Completed Welt 16 Feet Te:1 Length (Hours) Total Drawdown (Feet) <br /> Jaaol be repre ritative of a well's long term yield. <br /> LM-=2­ <br /> orehote Casings Wall Outside Annular Material <br /> Depth from B Scre3n Slot Size Depth from <br /> Surface Diameter Type Material Thickness Diameter Tyl:* If Any Surface Fill Description <br /> Feet to Feet inches J (Inches Inches (Inches) Feet to Feet <br /> Attachments Certifical <br /> 13 Geologic Log 1,the undelpined,certify <br /> that this ni-port is complete and accurate to the bestofmy knowledge and be <br /> at <br /> 13 Well Construction Diagram Name 1 Abandonment <br /> Person, r Corporation <br /> 13 Geophysical Log(s) Pe..n,Finnt o <br /> 9245 Be Drive Suite <br /> Sacramento <br /> CA 95826 <br /> 0 Soil/Water Chemical Analyses <br /> Sig AddressCft� S -Zip <br /> late <br /> ED Other -Site Map, Signed <br /> MIs 51291201^ 848359 <br /> .ch additional information.if it exists. U-0 7 Licensed Water Well ContrE. <br /> DVVR 188 RW It2006 C-57 License Number <br /> IF ADDITIONAL SPACE IS NEEDED,USE NEX r CONSECUTIVELY NUMBERED FORM <br />