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'The free Adobe Reader may be used to view and comj' his form. However,software must be purchased to complete,S' t tnd reuse a saved form. <br /> File Original with DWR State of California <br /> Page 12 of 18 Well Completion Report <br /> ReferOwner's No. e015507Well Number MW-12 a last 07 Pamphlet Mate Well NumberlSlte Number <br /> No. 82 N w <br /> Date Work Began 04/11/2012 Date Work Ended A11112012 <br /> Latitude .. Longitude . <br /> Local Permit Agency gS_ n County <br /> auin -Environmental Health DeDertment <br /> Permit Number 15502064 Permit Date 2129112 APNfrRSlother <br /> . r <br /> Orientation O Vertu al O Horizontal OAngle Specify. Name Wight Hpldin s Inc. <br /> Drilling Method Au er Drilling Fluid <br /> Mailing Address°130 S.Wilson Way <br /> F .� . ' - • : _ _ C• Stockton !� State CA �� • 95205 <br /> 0 55 Overdrill 4 inch well to 55 feet. <br /> Address 130 5:Wilson Wav <br /> ' City Stockton _ � San Joa uin <br /> Latitude �� a gdude� � w <br /> rt <br /> Datum Decimal Lat �.Decima ong � <br /> APN Book Page Parce <br /> Township - an $sign <br /> s. Q N Well <br /> ' ' (� Modification/Repair <br /> O Deepen <br /> O Other. <br /> �;€ ;. >`�.. • Destroy <br /> y-, - Deardbe prooeduros and materials <br /> § unde <br /> r'GEDLOGIC L= <br /> O Water Supply <br /> ❑Domestic ❑Public s <br /> w <br /> ❑Irrigation ❑Industrial <br /> r �Cathodic Protection ; <br /> O Dewatering <br /> 11 �* O Heat Exchange . <br /> ' 0 Injection <br /> O Monitoring <br /> O Remediation <br /> }a;. O Sparging <br /> ' -South 0 Test Well <br /> s;a- ::.£ ``:x` - IGilslrate w olesvKibe distance o1 yell Nam roads.W9tlir�s,fences. O Vapor Extraction <br /> 2-- -' - rl+ .etc.and attach a map,.Use additional paper tr necessary. O Other j <br /> . �� �, - PI*aea Ee accurate entl corn - <br /> eta ' <br /> R> rf e 71 Depth to-first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of�or1Yi'9 rS5 Fleet Estimated Yield* (GPM) Test Type I <br /> Total Depth of ompleted Well 77 777 yFeet Test Length (Hours) Total Drawdown (Feet) !I <br /> *Ma not be representative of a waif's fon term laid. <br /> Depth from ) rehole _ Ype Mateia Wall outside Screen Slot Size Depth from a <br /> Surface oteter .' Thickness Diameter Type ifAny Surface FIII Description <br /> Feet to Feet Irice"s` Inches Inches Inches Feet to Feet <br /> h <br /> 4 <br /> - <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 Casode Drilling.L.—P -- _ <br /> Person,Finn or Corporation - - <br /> ❑Geophysical Log(s) 3632 Ornec Circle Rancho Cordova CA 95742 P <br /> ❑SolllWater Chemical Analyses Ade ss city state zI <br /> P <br /> 0 Other Site Mao ___ _ Signed 4/26/2012 938110 l <br /> Anach additional information If it a els. G57 Licensed W r wen tracmr Date Signed G-57 License Number I <br /> DWR 108 REV.101006 IF ADDITIONAL SPACE IS NEEDED, SE NEXT CONSECUTIVELY NUMBERED FORM <br /> I, <br /> II <br />