Ltr: System removal & well destruction rpt, w/attchs 1-3

March 23 Ms. LynnU.S. EnvRegion 9Attention75 HawthSan Fran Subject: Dear Ms CB&I En

submit th

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SEMS-RM DOCID # 2363942

Ms. Lynn Suer March 23, 2015

Site Description

The former Jasco site consists of 2.05 acres located at 1710 Villa Street in the City of Mountain

View, California (Figure 1). The area is residential, dominated by single family homes to the

south and the Villa Mariposa apartment complex to the east. Villa Street is on the south side of

the site and PCJPB right-of-way borders the site on the north (Figure 2). Jasco operated a

chemical blending and repackaging business at the site from 1976 until 1995. The site was

placed on the United States Environmental Protection Agency (EPA) National Priorities List in

1989. A record of decision was issued for the site in 1992. The site has been remediated by a

combination of active soil and groundwater methods including soil vapor extraction, dual-phase

extraction and groundwater extraction and treatment and is in the process of being delisted by

the EPA. As part of the case closure activities, the EPA requested that the former groundwater

treatment system be removed from the property along with properly destroying the wells

associated with the site. The former well locations are depicted on Figure 2.

System Removal Activities

In April 2014, prior to well destruction activities, the existing treatment system was dismantled.

The two 55-gallon vapor-phase GAC drums and one vapor-phase GAC vessel were

disconnected from the former system, with the GAC removed from the vessel and placed into

another 55-gallon drum pending transport to an approved disposal facility. The remaining

equipment, consisting of an air stripper, former GAC vessel, softener, piping and pad were

placed into a roll-off bin pending off-site disposal.

Well Destruction Activities

Permitting/Health & Safety

Prior to starting well destruction activities, well destruction permit applications were submitted by

CB&I to the SCVWD for approval. Copies of the approved well destruction permits are included

in Attachment 1. In addition, right-of-way entry agreements were obtained from the Peninsula

Corridor Joint Powers Board (PCJPB) for work completed within the CalTrain right-of-way and

from the City of Mountain View and Cal-Trans for work completed along the Central Expressway

and Meridian Way.

A site-specific health and safety plan was prepared outlining safety measures to be

implemented during field activities. CB&I also worked with PCJPB to complete their required

Worker Protection Training for work within their right-of-way before beginning any field activities.


At least 72 hours prior beginning work, the statewide underground utility location number was

contacted to mark any utilities in the area. CB&I did not subcontract an underground utility

location company as the abandonment activities only involved the grouting of existing wells and

did not involve intrusive drilling methods. Subsurface work was limited to the removal of surface

completion materials such as well boxes, casing risers and concrete pads. The SCVWD was

contacted at least 48 hours in advance to schedule the inspection of well grouting activities.

Groundwater Well Destruction Activities

Due to scheduling and permitting delays, well destruction activities were performed in stages in

May and September 2014, with wells located on the 1710 Villa Street property and on CalTrain

right-of-way abandoned in May 2014, with the wells located along the Central Expressway and

Meridian Way on Cal-Trans and City of Mountain View right-of-ways abandoned in September

2014.

Prior to destroying the wells, the depth to the base of each of the wells was measured and

compared to well installation logs or construction details. The groundwater wells were then

abandoned by Woodward Drilling Company, Inc. of Rio Vista, California, a licensed California C-

57 driller, by pressure-grouting.

A pressure-tight cap was mounted on the top of each well casing prior to pressure-grouting.

The cap was equipped with a coupling allowing it to be mated to the grout injection equipment.

Pressurized neat-cement with up to 5 percent bentonite was injected into the well casing and

forced out through the well screens into the surrounding filter pack material. Pressure was

maintained at 25 pounds per square inch for 5 minutes or until pumping refusal. Following

pressure-grouting, the top 5 feet of well casing and surface seal were removed by drilling them

out using a drill rig equipped with the appropriately-sized hollow-stem auger. All well destruction

activities were completed under the oversight of the SCVWD inspectors.

Soil cuttings, concrete debris and decontamination water generated during well destruction

activities was temporarily stored on-site in two labeled, DOT-approved 55-gallon drums pending

off-site disposal. All wells were removed of surface completions which included “stove pipe”

monuments, flush-mounted traffic boxes, concrete pads, and bollards, with the debris placed

into the roll-off bin containing the previously-removed treatment system equipment.

The drilled out portion of the well casing was backfilled with clean soil. The ground surface at

each location was then restored to match the surrounding area.


Reporting

Upon completion of the field activities, Department of Water Resources (DWR) 188 forms were

completed by CB&I/Woodward Drilling. The forms have been forwarded to the DWR. Copies of

the forms submitted are also included in Attachment 2.

Waste Disposal

On April 25, 2014, the three GAC drums were picked up by Slaby Environmental of Capistrano

Beach, California and transported to California Carbon Company in Wilmington, California on a

non-hazardous waste manifest.

On October 14, 2014, the roll-off bin containing the removed treatment system equipment and

well destruction debris was transported off-site by Best Deal, Inc. under contract to Intrinisc

Transportation, Inc. to the Hay Road Landfill in Vacaville, California for disposal.

On November 11, 2014, the two drums containing soil cuttings and rinsate were transported off

site by Environmental Logistics, Inc. to Filter Recycling Services in Bloomington, California for

disposal as non-hazardous waste. However, one of the two drums was rejected from the

receiving facility due to a high pH level, likely from concrete slurry that had been placed in the

drum. On December 18, 2014, this drum was transported to US Ecology in Beatty, Nevada for

disposal as a hazardous waste.

Copies of the waste disposal documents are included in Attachment 3.

A copy of this report will be uploaded to the State of California’s Geotracker database. If you

have any questions, please call me at (916) 565-4343. Thank you for your support on this

project.

Sincerely, CB&I Environmental & Infrastructure, Inc.

Rob Delnagro, P.G. Project Manager/Quality Assurance


Attachments: Table 1 – Former Well Specifications Figure 1 – Site Location Map Figure 2 – Site Plan Attachment 1 – SCVWD Well Destruction Permits Attachment 2 – DWR Well Completion Report (DWR 188 Forms) Attachment 3 – Waste Disposal Documents

I‑01 05/13/14 05/15/14 2 13.5 7 62.5 Schedule 40 PVC 57.5 Steel 10 0–40 0.01 48.3–57.5 Lonestar #3 46.3–57.5 Bentonite 40–46.3 bent./cement 0–40I‑02 09/11/14 09/12/14 2 13.5 7 59.5 Schedule 40 PVC 54.5 Steel 8.6 0–40 0.02 49–54.5 Lonestar #3 47–54.5 Bentonite 45–47 bent./cement 0–45I‑03 09/11/14 09/12/14 2 13.5 7 71 Schedule 40 PVC 56 Steel 8.6 0–21 0.02 49–56 Lonestar #3 46.5–56 Bentonite 43.5–46.5 bent./cement 0–43.5EW‑6 05/12/14 05/15/14 2 8 8 24 Schedule 40 PVC 24 NA NA NA 0.02 12–22 #2/12 10–24 Bentonite 8–10 bent./cement 0–8EW‑6A 05/12/14 05/15/14 6 12 12 20 Schedule 40 PVC 20 NA NA NA 0.01 9.75–19.67 #2‑12 8.75–20 Bentonite 6.75–8.75 bent./cement 0–6.75EW‑7 05/14/14 05/15/14 6 19 12 64 Schedule 40 PVC 64 Steel 14 0–40.5 0.02 44–59 Lonestar #3 42–64 Bentonite 40.5–42 bent./cement 0–40P‑1 05/13/14 05/15/14 2 12 8 43 Schedule 40 PVC 41.5 NA NA NA 0.02 31–41 #2/12 28–41.5 Bentonite 26–28 bent./cement 0–26P‑2 05/13/14 05/15/14 2 8 8 43 Schedule 40 PVC 41 NA NA NA 0.02 30.5–41 #2/12 28.5–41 Bentonite 26.5–28.5 bent./cement 0–26.5P‑3 05/13/14 05/15/14 2 8 8 41 Schedule 40 PVC 40 NA NA NA 0.02 32–40 #2/12 30–40 Bentonite 28–30 bent./cement 0–28P‑4A 05/14/14 05/15/14 2 8 8 36 Schedule 40 PVC 36 NA NA NA 0.02 26–36 Lonestar #3 25–36 Bentonite 23–25 bent./cement 0–22.5P‑4B 05/14/14 05/15/14 2 15 8 59 Schedule 40 PVC 56 Steel 8 0–40 0.02 44–56 Monterey #3 42–56.5 Bentonite 40–42 bent./cement 0–39.5P‑4P 05/14/14 05/15/14 2 8 8 21 Schedule 40 PVC 21 NA NA NA 0.02 13–21 Lonestar #3 12–21 Bentonite 10–12 bent./cement 0–9.5P‑5A 05/14/14 05/15/14 2 8 8 36 Schedule 40 PVC 36 NA NA NA 0.02 26–36 Lonestar #3 25–36 Bentonite 23–25 bent./cement 0–22.5P‑5B 05/14/14 05/15/14 2 15 8 70 Schedule 40 PVC 65 Steel 8 0–39 0.02 45–65 Monterey #3 43–65.5 Bentonite 39–43 bent./cement 0–38.5P‑5P 05/14/14 05/15/14 2 8 8 21 Schedule 40 PVC 21 NA NA NA 0.02 13–21 Lonestar #3 12–21 Bentonite 10–12 bent./cement 0–9.5V‑01 05/12/14 05/15/14 2 8 8 50 Schedule 40 PVC 48 NA NA NA 0.01 28–47 Aquarium #4 26–48 None NA bent./cement 0–26V‑04 05/13/14 05/15/14 2 8 8 40.5 Schedule 40 PVC 36.5 NA NA NA 0.01 33.5–36.5 Lonestar #3 32–36.5 Bentonite 31–32 bent./cement 0–31V‑05 05/13/14 05/15/14 2 8 8 47.5 Schedule 40 PVC 42.7 NA NA NA 0.01 37.5–42.7 Lonestar #3 35.5–42.7 Bentonite 34.5–35.5 bent./cement 0–34.5V‑06 05/14/14 05/15/14 2 8 8 42.5 Schedule 40 PVC 35.5 NA NA NA 0.01 24–35.5 Lonestar #3 22–35.5 Bentonite 21–22 bent./cement 0–21V‑07 09/11/14 09/12/14 2 8 8 49.2 Schedule 40 PVC 37 NA NA NA 0.02 32–37 Lonestar #3 31–37 Bentonite 28.5–31 bent./cement 0–28.5V‑08 09/11/14 09/12/14 2 8 8 33 Schedule 40 PVC 28 NA NA NA 0.02 23–28 Lonestar #3 22–28 Bentonite 20–22 bent./cement 0–20V‑09 09/11/14 09/12/14 2 8 8 38 Schedule 40 PVC 32 NA NA NA 0.02 25–32 Lonestar #3 24–32 Bentonite 22–24 bent./cement 0–22V‑10 05/12/14 05/15/14 4 10 10 40 Schedule 40 PVC 35 NA NA NA 0.01 28–35 Lonestar #3 27–35 Bentonite 25–27 bent./cement 0–25V‑10A 05/12/14 05/15/14 6 12 12 36 Schedule 40 PVC 35 NA NA NA 0.01 24.5–34.5 #2‑12 23.5–36 Bentonite 21.5–23.5 bent./cement 0–21.5V‑11 05/12/14 05/15/14 4 10 10 41.5 Schedule 40 PVC 41.5 NA NA NA 0.01 31.5–41.5 #2‑16 30–41.5 Bentonite 29–30 bent./cement 0–29V‑12 05/13/14 05/15/14 4 10 10 42 Schedule 40 PVC 41.5 NA NA NA 0.01 31.5–41.5 #2‑16 29–41.5 Bentonite 28–29 bent./cement 0‑28

Notes:# number

bent. bentonitebgs below ground surface

ft feetin inches

NA not applicablePVC polyvinyl chloride

1) date well was pressure grouted under supervision of SCVWD2) date surface restoration was completed

Table 1

Former Jasco Chemical Corporation Facility1710 Villa Street

Mountain View, California

Former Well Specifications

Screened Interval (ft

bgs)

Filter Pack MaterialWell #

Casing Diameter

(in)

Borehole Diameter

(in)

Borehole at Screen (in) Casing Type

Casing Depth (ft

bgs)

Well Destruction Completion

Date2

Well Destruction Inspection

Date1

Borehole Depth (ft

bgs)

Conductor Casing Material

Conductor Casing (in)

Conductor Casing

interval (ft bgs)

Slot Thickness

(in)

Filter Pack Interval (ft

bgs)

Backfill Material

Backfill Interval (ft

bgs)

Sanitary Seal

Material

Sanitary Seal

Interval (ft bgs)

FIGURES

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FORMER JASCO CHEMICAL CORP. MOUNTAIN VIEW, CA

FIGURE

SITE LOCATION MAP

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FORMER JASCO CHEMICAL CORP. MOUNTAIN VIEW, CA

FIGURE 2

SITE PLAN

ATTACHMENT 1

SCVWD WELL DESTRUCTION PERMITS

Santa Gara Volley Wale, Dislric!()

5750 Almaden Expressway San Jtise, CA 95118-3686 (406) 265-2500

WELL DESTRUCTION APPLICATION FC 198 (10-18-10)

Page 1 of 4

► Please complete an infu1111a:lio11. DISTRICT PERMIT i,~ DOV s ~ <(' Well Owner: Property Owner: HM. Anthony Marital Deduction Trust. Name of Bus ncss/Rosidcnco :it Sile: The Homax Group, Inc. Carol Jean Anlhony, Trustee Fanner Jasco Chemical Corpollll.loo . -Well Owner's Malling Address, Property Owner's Mailing Address: Address of Well Site: i &35 Ba,l:lcy Blvd., Suite: l ()] 331 Cypress Poinl Dr. l710VillaSl City, State , Zip City, Slate, Zip City, Slate, Zip Bellin~ WA 98226 Mountain View, CA 94043 Mt1W1t.ain View, CA 94041 Telephone No.: TelBphcne No.: Assessors Parcel No. ofWeH Site: 360.733 .9029 >-2756 6S0.961.0:Z07 Book ,W Page m Parcel (!_Q.! Consultant Drilling Company: CB~l W~odward DrillJna: Company, Inc Address: Address: 4005 Port Chicago Highw21 550 Ri\•cr Rrnul City, State, Zip City, S!alB, Zip CJnccrd. CA 94520 Rio Vista,. C,\ 94571 Telephtine No_: Telephone No.; I C-57 License No.: 925.288.2274 707.374.-4300 710079 0 Chedc if addre5li or phtme number has changed 0 Check if addras~ or phone number has ctienged

► All questions below are to be completed before permit can be issued; if unknown, applicant shall make on-site Investigation to determine correct answers.

This Section lo Be Completed for All Monlloring Wells or Extraction/Recovery Wells

Case Name/No .:

Oversight Agency: EPA D Well on Districl property/easement (See General Condition E.)

Well Description~

Caseworker Name: Dr. LyMSucr

caseworker Telephone No.: 415.792.3148

~ Verfk:al We II O Dewatering Well O Elevator Shalt O Multiple Casing O Horizontal Wall O Pit Well Well Type (checl( all that appl)'):

~ Wat.er Producing D Contamination Cleanup (supply or extraction)

0 Vapor Extraction

D Piezometer

0 Contamination Cleanup

D Monitortni,

0 lnterfaoe

D Reclaimed Waler

0 Agricultural 0 Domestic:

D Inclinometer 121 Groundwater

D Suction Lyslmeter O Seismic

0 >J.r Spatglng O Cathodic Protectiot'I

□ Munldpal & Industrial

0 Vadosa

D lnjei:Uon/lnfil!ralkin

•••gffi~Jei:ilf4S-lfmm-!Wiiihiii&im Does the well have: ,.

2.

3 .

Type of Original Drilling Metl'lod:

Outer conductor casing?

Annubr oomenl !leal oUUilde of = Ing nt ,urfaoc? A s_c_vw.o. water rncl1>r all.aehed?

0 Rotary □ Cable-Tool · 0 Hand-Dug P~ Well !81 Hollow Stem Auger

D Yes 181 No

0 Ve:;

D Yes

0 Olher:

0 No

Ci?J No

IMPORTANT: A n1mm1urr 24-how 11 ol1ce must be 9 1ve11 to Santa Clar.:i Vall ey W.iter D1stnct prior tr. ,ns talhng the annular -:;e;il Call (4013) 265-2607, C'Xt 2660. Please allow 10 working days to process perm rt appl1cat1on

Sonlo Cleta VoRey Wale, Di,hic~

5750 Almaden Expressway San Jose. CA 95118--3686 (408} 265-2600

WELL DESTRUCTION APPLICATION FC 198 (10-18•10)

Page 3 of 4

Please describe in detail, the proposed deE:truction method (Any well destruction in which the well casing is left in place tmd in whic:h the well has a filter pack outside the casing, must be destroyed using approved neat cement grout): NC3\ cement i;rout will be pumped into 1bc well casing starting from "Wll bottom to five fo:t below ground surface. Aller lhe cement bas set for amioimum of30 minutes, !he re111ai11ing 5 feet will be filled with tooacte. All displaced ground waler will be captured end disposed ofproper:ly.

I understand and agree that all work associated with this permit is required lo be done in accordance with Santa Clara Valley Water District {District) Well Ordinance 90-1, 1he District Well Standards, and conditions of this permit (see page 4). I certify that the infonnalion given in this pArmit is cnrrP-r.l In the bP.i;\ nf my lmowlP.Clge ;.mci ttiat the si□nc1ture bl:!low, whether origin.:il, l:!lectronic:, or photocopied, is authorized and valid, and is affixed with the intent to be enforceable. I also c:ertrfy that a right of entry/encroachmenl agreement has been formalized between the well owner and properly owner, if pru1ll;lS differ.

Print Na,na: Date: / I

{ /17.13 / /

Signature of Property Owner/Agent • Date:

~~ -C-Cel?{

, ,('.\'\.,fl ,,,,o,,), t_ v~t~o, .. "'"i'\ . 6 Signature of Consultant/A.90111 (if any): ·

,I

s approved !lowing destruction methods for the well described in this permit:

?'l Pressure Grout Method (as outlined In Standards} ~fe.: Niµit cament is 1he only se;aling rnalerial approved fpr pressure grouting.

~ Drill out well to a (olal depth of- h, ':f feet, with a minimum bore of ~ Inches.

□ Cleiln out well casing to a total d11pth of _________ feet and back fill with approved sealing malarial (if total depth is unknown, driller must determine total depth during cean out of well). NOTE: Neat cement is the only sealing material approved for back filling gravel packed wells_

□ Well casing mus! be perforated at the following dephs prior to backfilffng:

□ Other:

Permit Approved by; i Dale:

District Permit No{'.?\) OO 5ft, 8'

Sonlo Clora Volley Waler Disbiq 6 5750 Almaden Expressway

San Jose, CA 95116--'.!666 (40B) 265-2600

WELL DESTRUCTION APPLICATION

DISTRICT PERMIT NO.;

FC 198 (10-1B-10) Page, of4

~ Pleo:;c complete all infcnnation. /3D0 0 Sb7 Well Own&r:

The H:inw; Group. lnc.

Well Owner's Malnng Addre5s: I 835 Bllddcy Blvd., Suite I 01

Ctty, State. Zip BcUingham, WA 98226

Telepi,one No . . 360.i.33.!1029 x2756

Consultant: CB&!

Address: '1005 :Pon Chicago Highway City , Slate, Zip

Concord, CA94520

Telephone No.: 925.188.2.274

0 Check if eddre9s or phone, number has chanQad

Property Owner: HM. Anthony Marital Doduotion Trust, Carol Jean Andiony, Trustee

Property Owner's Man\ng Address: 331 Cypress Point Dr.

City, State, Zip Mountain View, CA 94043 Telephone No.: 650.96 l ,Jl07

I OriMing Company: Woodw:ird Drilling Curi Addtess: SSO River ROIMI

City. Stele,~ Ria Vim\ CA 94S71 Telephone No.: 707.374.4300

Name of BUSiness/Residence at Stte: Fomii::r Jasc:o Cbemioal Corponllion

Address of Well Situ: J?IO Villa St

City, Stale, Zip Mmwtain View. CA 94041

Assessor's Parcel No. cf Well Slla: Bcok ~

, Inc

Paga l!Z

C-~7 license No.: 710079

0 Check if addregi; or phone number has changed

Parcel 001

► All questions below are to bit completed before permit ~n be issued; If unknown, applicant shall make on-sit. Investigation to determine correct answers. · ; • .,

Well Casing Depth: 41.5'

Tolal Boring Depth! ~:2·

WeD Casing Diameter: 4•

This Section to Be Completed for All Mooltortng Wells or Extraction/Recovery Wells Case Name/No.:

Oversight Agency. EPA D Well on District property/easement (Sae General Condition E.) Well O!tBCrtptlori;

Cai;ewori<er Name: Dr. Lynn Sue,-

Casewor1<er Telephone No.: 4IS.792.)148

~ Vertlcal Well O Dewatering Wei O Elevator Shaft O Multiple Casi~ 0 Horizontal Wall O Pit Well Wall Type (check aU that apply):

D Wale, Producing 0 Contamination Clsanup 0 Agricultural {i;,up?,ly or e,c1radion)

D Vapor Extraction 181 Monitoring D lncllnQllllller D Piezometer 0 lnlerface 0 Suction Lyslmeter D ContiJl'Tlinatlon Clea~up D Reclaimed Waler 0 Air Spa~lng

1. Outer conductor casing?

2. Annular cement seal outside of casing et sutface? 3. /4, S.C.V.W.D. watermeterattactiad?

Type of Original Drilling Melhod:

0 Rotary O Cable-Tool O Hand-Dug Pit Well r&I Hollow Stem Auger

□ Domesl1¢

181 Groundwater

□ Se!sniie

□ Calhgdii. Protection

0 Yes 181 Yes

D Yes

□ other:

f8I No

0 No ® No

0 Municlpal & Industrial

0 Vado~e

D lnjec.tlon/lnflltration

IMPORTANT· A rrnn1111urn 24-hou• notice- ,nu5t he urvC?n to Snrlta Cl;ir;i Valley \o\ntcr D1:,tr1ct prwr to 111st.:ill1n □ tl,e r1nnul;ir seal Call (408) 265-2607 . ext 266n Please allow 10 wor~1n9 cays to !)•oc:ess permit 3polrc.:it,□n

Sanla G~(O VaUA11 Wole< Distri<i (5 5750 Almaden Expres:.way

San Jose, CA 95118-3686 (408) 265-26□0

WELL DESTRUCTION APPLICATlON FC 198 (10..18-10)

Page3of4

Please describe ln de-tail, lhe proposed destruction met"'od (Any well destruction in which the well casing is left in place and In which the well has a filter pack outside the casing, must be destroyed using approved neat cement grout): Neal ccm:ntgrout will be pumped i!lto 1he well casing lllldtm& from well 1,onom lO five feet below ii'Durul SlllllCC. Aile:r 1h11 c.c:m=t bas set for a minimum of30 mimltJ:s, the remaining 5 feet will be filled wilb concrete. All displaced groundwater will be captured ll!ld disposed ofpro)JClly.

I ul'ldersland and agrt!~ lhal all wor11 associated With this permit ls required to be dona In accoraance with Santa Clara Valley Water District (District) Well Ordinance 90-1, the District Well $1and~rds, and conclttions of this permit (see page 4). I cel11fy that the informailon given ln !his permil Is correct. to the best of my knowledge oriel ttial the signature below, whether original. elBCtronlc. or photocopied. is a~lhorized c1nd va/ld, and 1$ affixed with lhe Intent to be enforceable. I ~lso certify that a riohl of entry/ena:Qactimenl agreement has been formalized between lhe Well owner and property owner, if parties differ.

erll\geru: ~ Signature of Well Print Name: Date: ,,

;fo~s- C&9wSo/l/ i .f ;7;.f 3 ___ _u~~-lL::fl_g JI - ------+--r---/--..;;..._---1 Signature of Property Own.or/Agent:

~,{~l Oite:

'1(~/13 ' PrtntName: Date.:

L

The District has win destruction methods for the well desaibed in !his permit V( Pressure Grou1 Method (as ·outlined in Stamiards)

N!),TE: Neat cement is the only sealing material·approved for pressure grouting, 01<... . -'j4 Drill out well lo a total depth of 't 2 fee~ with a minimum bore of _..1./_D _______ Inches.

D Clean out wen casing to a total depth of _ _ ______ feel and back fill with approved sealing material (if total depth la unknown, drlller must determine total depth during clean oU1 of well). NO'! E:: Neat cement Is the only sealing material approved for back filling gravel packed well;,

□ Well casing must be perforated at the following depths prior to backfiRing:

D Other:

PermilApproved ey:

13 District Perml\ No.:

~-----

Sonlo Claro VcUey Waler Dul,{) S750 Almaden Expressway

Son Jose . C,' 951 1 S-l 68G (408) 26s-260C


Page 1 of 4

► Please complete all \nfonnatlon. DISTRICT PERMIT,~ DD O c:;1,,/,,,, Well Owner:

The Homax Gl'QUJ'I, Inc_

Woll Owner's Malling Ad::lress:

J 835 B11rklel Blvd., Suite :01

Cily, Slate, Zip

Rclllogt,11111, WA 98216

Telephone No.:

360.733.9029 x2756

Consultant

CB&:.1

Address:

4005 Pert Chicago Highway

City, State, Zip

C~m:ord. CA 9~520

Telephone No.:

915.28&2274

D Check If address or phone number hillS chan911d

Property Owner. KM_ Anthony Marica! Deduction Tru<t, Name of Business/Residence at Site: Carol Iean An1hooy, Truscoe j fOllDl:r Jasco Cbemiclll CqipQBlion

Property Owne~s Malling Address: 331 Cypross Point Dr. City, Sta!t, Zlp

Mountaiu Vic:w, CA 94043

Telephone No.:

6S0.96l.Cl207

Drilling Campany:

' Address of Well Site;

171D Villa St

City, State. Zip ! Mmmtaiu \lic:w, CA 94041

Assessor's Parcel No, of Well Sita: Book ill Page Ql

Woodward Drilling Campany, Ji!i; Address: 5S0 River Road

City, State, Zip

Rio Vista. CA 94571

Telephone No.: 707.374.4300

I C-57 License No.: I 710079

D Check if addreH or phona number has changed

Parcel !l!!J.

► All questions below are to be completed before permit can be issued; if unkrtown, applicant shall make on-site invesUgation to determine correct answers.

~Jf~[jA~~~~·~~.~-...-:;-~~~3!~~.:•;•.~·~·i.~,t~;i,i•~ ·:•:-.~ ·. ·•·:~*~~}~"-\'1-·:~·~\ · t: · . . ~i~ i~~:;<t~J'\tf:{~·;·::~ :·:J;?:f~~~;/~~:-::•.' · ~.r~~~-f~~~/?, gs;_:~ _1l{-i'!"~;;:lj!t.!£.-i::~~~1{.~·;~~iJ{r..;~: :t'1jr";-·~ E..1.~:g.~·-•;:~- ·.-. -.- i ,7:tfil!t~~xfi-t-~:!:;l~!~~t!fft~!!"• h-.~~-:t.~?,: .~.~¥~!:_._,·.\ -·•· .. ::j1ilg,Jr.~•~•Z· .. ~--:~· ..... ,7,:ltif~~~~ .· ;;-.. ~ • Original Well Construction Permit No.;

tJf://,2 ?C. Wen Ca5ing Dep th: 41.S'

Total Being Depth: Well Casing Diameter: 4•

This Section lo Be CornpletBd for All Monitoring Wells or Extractlon/RICDVIH)' Wells Case Name/No.:

Oversight Agency:

E."A

0 Well ex, District proparty/easemenl (See Genaral Condition E.)

Well Ds!llcrfption:

Caseworker Name: Pr. L)-un Su:r

Caseworker Telephone No.:

415.'792.3148

121 Vertical WeH O Dewa\ering Well O Elevator Shaft O Multiple Casing O Horizontal Wall O Pit Wei

Well Type (check all that apply):

0 Water Producing 0 Contaminatlon Cleanup D Agricullural (supply or extrodlon)

D Vapor Extraction @ Monitoring D lndlnometer D Plezoml?ter D Interlace D Sudion Lysimeter

0 Contam~atlon Cle11nup . D Redai(T\~ Waler D Air Sparging

OoeG the well have: 1. Outer conduelar cusing?

2. Annular cement seal outside of casing at surface? 3. A s_cvw.o. water meler attached?

Type of Original Drilling Method:

0 Rotary 0 Cable-Tool 0 Hand-Oue Pit wen 181 Hollow Stem Auger

0 Domestic

~ Groumlwaler

D Seismic

D Cathodic Protection

0 Yes

181 Yes

D Yes

D Other.

~ No

D No ~ No

0 Municipal & lnduwial

0 Vadose D lnjactlon/lnflltratlon

1rJJPORTAN r : A rn11111rnJ1n 24-hou, nonce lllUSt hr> given to Santa Ckua V.ille:y Vi,';iter District nrior ~o mslall,119 tl1c -m11ul;ir seal Call (408) 265-260,, ext. 266Q _ Plc,.;sc ;:illow 10 worf-.1n9 days to process pc1m1t ;ipµlac:it,on

5750 Almaden Expressway San Jose, CA 95118-3686 (408) 26$-2600


Page 3 of 4

----------- ----------- ------ --- - ----------- - - - - -----, Pleiii;e tles1.,iue in delail. the µroposi,d destruction method (Any well destn.iction in which the well caalng ls left in place al'\d Ii Which the well has a filter pack outside the casing, must be destroyed using approved neat cement grout):

Neal""'"""' e,,0111 will be :,umped inro th,: .vell casiog starting from wcU bottom to five f..,t below g,ou,1d sumcc:. A!lo: the cement has set fun minil;num of30 minur,s, the remainin~ S feel wiU be filled \\~th concrete. All displaced grouadMler ",11 be captured 811d dispo~ of properly.

l understand and agree that all wort associa1ed with this permit ts required to be done in accordance with Santa Clara Valey Water District (District) Well Ordinance 90-1. the District Well Standards, and conditions of this permit (see page 4) . I certify that the information given in this pF!rmit i!l mrrer.t tr> the bf:!1.t nf my knnwl~.rl!Je !!f1d t1ic1t the sigf'lature below, whether original, electronic. or photocopied, is aulhortze.d and

valid, and is affixed w'th the intent to be enforceable, I also certify that a right of entry/encroachment agreement has been formalized between ,

the well owner and pr::iperty owner, if parties differ.

'on rnethodi; rar the well described in this permit:

~ P,ressure Grout Method (as ouilined in Slani:lerds) NOOT.,e: Neat cement-is the only sealing mate-rial approved for preasuro·grouting.

Debt: ,,.(,_ / / / /17 /? o .. . / / .J

Date:

_3

~I( ~ Drill out well to a total depth of ~ '2_ feet, wlth a minimum bore- of - -1./--=D:;..._ _____ Inches.

D Clean out well casing to a lotal depth of ____ _____ feet and back fill with approved sealing material Of total depth is

unknown, driller must determine total depth during dean out of well). NOTE: Neat cement Is the only sealing material ap:iroved for back filling gravel packed wells .

□ Well ca&ing must oe perforated at the follow1ng depths prior to backfllnng:

D Other:

Perm1t Approved by:

/3 District Penni\ No.:

Sonlo Cla10 Voffey WolerD~

5750 Almaden Expressway San J0se, CA 95118-3686 (408) 265-2600

WELL DESTRUCTION APPLICATION FC 198 (10-1~10}

Page1Df4

... Please complete au information . DISTRICT PERMIT ''ttoo oq?l) Well Owner. PropeftV owner: HM Anthony Marital Deduction Trust, Name of Business/Reskllmce at Site: The: Holtlilll Oi-01111; Inc. Cami Jean Anthony, l'ru,teo former Jesco Chemical Qirpontion Well Ownefs Malling Acdress: P10perty Owner's Mai~ng Address: Address of Well Site: 1835 BllfldcyBlvc!., Suite 101 331 Cypn:ss Point Dr. 1710 Villa St City, State, Zip City, Slate, Zip City, St;1ta, Zip Bcllinghlllll, WA 982Z6 MoWJtaia Vii:w, CA. 94043 Mounwn View, CA 94041 Telephone No.: Telephone No.: Assessofs Parcel No. of Well Si!B'. 360.733.9029x2756 650.961.0207 B00k l.li Page .az Parrel !1:Q2 Consultant: Drillin~ Company: CB&J Wnn~word Orilling rmnl"'"Y, Jnr. Address: Address: 4005 Pon Chicago Highway S50 Rlvcr Road City. State, Zip City. Slahl, Zip Concord, CA 94 520 llio VJ~ CA 94571 Teleph0ne No.: Ta[11phone No.: I C-57 License No.; 925 .288.2274 707 374.4300 710079 D Checl< if 3ddress er- phone number has ohangad 0 Check if add~s 0r phone number has changed

,.. All questions bel01111 are to be completed before permit can be Issued; If unknown, applicant shall make on.:ite Investigation to determine correct answers_

Well Registration No.: , . J -, 0 rt, 5 O ,;:lvv ~ I .,C() ;i. 9

Owner/Consultant Well Na.: Original Well Conslruclian Pcmnll No.: wdtJ::21~ V-lOA

Well Casing Depth: ~s·

Total Bo'ing Depth: 36'

Well Ca'1,ing Dlamelor: 6"

This Section to Be Completed for All Monitoring Wells c:ir El:1nlcliontRecovory Wells Cese Name!N0.:

Oversight Agency;

EPA D Well on District prnpertylees .. rnent (See General Condition E.) Well DescripUon:

Caseworker Name: Dr. Lynn Suer

Caseworker Telephone No.: 415.792.3148

lg) Vert1calWell O OewaleringWell O ElevalorShall O MullipleCuing O HoriwntalWall O PltWeJI Well Type (c~ck all that apply): [g( Water ProdiJdng O q<>ntamlrtation Cleanup O Agrlci,liural D Domestic. (supply 0( extrac:li0n)

0 Vapor Extraction

0 Plezometer D Contamination Cleanup

Does the well have:

D Monitoring

D Interface

D Reclaimed Water

1. Ouler conductorcasll'IQ?

0 Inclinometer

0 Suction Lysmeter 0 Ar Sparging

2. Annular cement :ieal oulslda af casing at surface? 3. A S.C.V,W.D. wa\armete(atlached?

Typ1t of Orlglnilll Drilling Method:

0 Rc,,'ary O Cabli,-Tcol O Hand-Dug Pit Wvll ® Hollow Stem Auger

181 Groundwater

D Selsmlc

□ Cathodic Proteelion

0 Yes 181 Yes

□ Yu

0 Other:

fBI No

□ No 181 No

0 Mu11lcil)ail & lndostrlal

0 Vadose

0 ln)ectlonllnffllration

IMPORTANT /.,, rrn111mu rn 24-11ou, not,cl' must bC: g,vcn tc S;ir.t,, Cliir2 '✓allC'y WatL"I D1&trict µr,o, to 1n~t;:ill,n9 tl1c- J1111ular sc,ll . C:il , (408) 265-2607 ext. 26GG PIC'il&(' o1llow 10 WOI ls.,ng days tu pruCt;~S fJE,1 JIii! .1ppli l:d l101 '

j/ ,.

Soo~o Cloto Vallt=tij Wole, Dislri,~

5750 Almaden Expressway San JOSI!, CA B5118-3686 (408) 265-2600


Page 3of 4

Ple11:.e 1.h:1scribe in delall, U1t: µruµu:;t!d ueslruuiu11 rnethull (Any well tles1rucllu11 In which the well cash1g is len In piece and In which the wall has a filter pack outside lhe casing, must be destroyed using approved neat cement grout): Near cement grolll l\ill be pwnpcd into tb• well casing SlaltiDg from well bottom to five fed bolow g:rowid surfaec. After the ccmonthas set for a minimum of30 mu,1115, th~ reroaiil.ing S feet will be filled wilb conc:rt:lc. All displaced groundwatr.rwill be cap!Wed aod disposed ofprorerly.

I understand and agree ttiat aU wortc associ~led with this permit is required to be done in accordance with Santa Clara Valley Water District (District) Well Ordinar>ee 90-1, the District Well Standards, and conditions of this permit (see page 4). I certify that the information given ln this permit is rorre.d lo lhF.! best of my knowledge and th~I the 1:i9Mture below, whether original, electronic., or photocopied, is authorized and valid, and is affixed with the intent lo be enforceable. I also cenify lhat a tight of entry/encroachment agreement has been formalized between !he well ovmer and property owner, if parties diff_e_r·-- ----~-------------------------;

Print Name:

M~s Signature of Property OwncliA9ent: Print Name:

Tl1e District has approved h following· destruction melhods fur the well described in this permit:

f;4 Pressure Grout Method (as outlined In Standards)

Date:

,~/13 Date:

l: 1~· ~ I

NOTE: ~e~menl is the only sealio~ material approved ror press:ure grouting.

~ Drill oul well to a total depth of ':> 5 feel, wtth a minimum bore of ___ /_2-______ Inches.

□ Clean out well casing to a total depth of ___ ______ feet and back fill with approved sealing material (If total depth is unknown, driller rr.ust determine total depth during clean out of well). NOTE: Neat a:iment is the only sealing material approved for baclt filling gravel packed wells,

□ Well casing must be perforated at the following depths prior lo backfilling:

□ Other,

Permit Approved by:

13 □lstrlct Permit No.:

I

5750 Almaden Expressway San Jose , CA 95116-3686 (408) 265-26.J0


Page 1 of 4

► Please complete all information. DISTRICT PERMIT tl(lj ,r--/ :>DOD '57o::::,

Well Owner: The Homax Group, Inc.

Property Owner. KM Anthony Marital Deduction Trust, Carol Jean Anthony, Trustee

Name of BL15lness/Res.ldenca at Site: Fonner Jmc:o Chemical Corpormion.

Well Owne~s Malling Address: 1835 Barkley Blvd., Suite I 01

City, Stale, Zip Bcllinsh:un. WA 98226

Telephone No.: 360.733.9029x27S6

Property Owner's Mailing Address: 331 Cypms PoimDr.

City, Staie, Zip Mountairo View, CA 94043

Telepho,e No.: , 650.961.0207

Address of Well Site: 17!0V"illaSt

City, Slate, Zip Mounlllin View, CA 94041

Assessor's Parcel No. cf Well Site: Book IM Page l!l Pam ll2l

Consullant CB&! I Drflllng Company:

\l/0Qd9,-.rd Drilliag Co.mpllDY, ID~ Address: 40uS Port Chicago Higbwa.y

City, Stale, Zip Concord, CA 94520

Telephone No.: 925.2SS.21i4

' Address: SSO Rlvcr Road

City, State, Zip Rio Vista, CA 94571

Telephone No.: 707374.4300

C-57 License No.: 710079

0 Check if address or phone number has Changed. 0 Check if address or phone number hu changed

► All questions below are to be completed before permit can be issued; if unknown, applicant shall make on-slte investigation to detennine correct answers.

Well Ri:,g!;j.trallol'I No.: . Ovmer/Consultanl Well No.:

0.&JS();).{/l};L / Ft)() 7 V-10 Original Well m~ oinn:¥

Well Casing Depth: Total Bering Depth: wen Casing Diameter. Jr 3W

This Section to Be Completed for All Morittorlnu Wells or Extnlctlon/Recovery Wells

Case Name/No.:

Oversight Agency: EPA

Ca58W0rker Name: Dt. Lyun Su~

C.neworl{er ToleJ)hQ/18 No.: 415.792.3148

D Well on District p10pertyle11Sement (See General Condltlo11 E.)

Well O"su;,ription:

[81 Vertical Well O Dewalertng Well O Elevalcr Shaft

Well Type {check all that apply):

0 Multiple Ca5ing

D Agricunural

0 Horlzontal Wall O Pit Wall

0 Waler Prgdu,:u\g (supply er extracllon)

D Vapor Extmdlon

0 Piezometer


Does the well hava:

[J Contamination Clei,inup

fgj Monitoring

0 Interface

0 Reclaimed Water

1. Outer conductor casing?

D lni::Nnom!9!er

□ Suction Lysimeter 0 11Jr Sparglng

2. Annurar =en! seal cuts\dc or casing at 1.urfac:e?

3. A S.C.V.W.D. waler meter attached?

Type Of Original Drilling Method:

0 Rotary O Cable-Tool O Hand-Dug Pil Well 181 Hollow Stem Auger

0 Domestic

tgi Grounclwater

0 Se!smlc

0 Cathodk: Protecclon

D YIIS

l&1 Yes

0 Yes

□ other.

fB2 No

0 No

fBI r-lo

0 Municipal & lndu&trial

0 Vadose

D lnJedi11nnnfifuation

IMPORTANT: A minim urn 24-lmur 11oticl' must be given to Sant:, Cl.irce V.illu,· W.itcr District prior to 111$tal11ng the ;,nnui;ar ~Eal Call (406) 265-2607. <::XI 2660. Please allow 10 workrng ddys to process pcrrn,t apµllc;1t1on

Sonla Ooro Vo!ey Wolet o;M<\ 6 5750 Almaden Expressway

San Jose, CA 95118-36B6 (408) 265-2600


Page 3 of 4

Please describe in detail, the proposed destruction method (Any well destruction in which the well casmg is left in place and in which the well has a filter pack outside the casing, must be destroyed using approved neat cement grout)· Neat cc:mcnl grolll will~ :;,11,nped into the well c.&sing <tarting from well bottom to five fcel below ground surfllce. ~ lhe cement bas sclfor a minimwn of30 lllimrti::;, tha remaining S ~ \\ill be filled wilh coocn::le. All dis:,laud groundwalcr will be captured aod disposed of properly.

I understand and agree that alt woe!( llSSOCialed with this. pennit Is required lo be done in accordance with Sen1R Cla:ra Valley Water District (Clstiici) Well Ordinance 90-1, !tie Dls1tlt:1 wan Slandan:ls, and conditlons of this. petmlt (s1:e page 4}. 1 certify Iha\ the tn rOITT\alfon given In this perm!t ls correct to ths be.st ofmv kt:towicdgc .ind thnt \!'.le sign,:iture below, whether otiglnal, elect.tonic, or photocopied, rs authonzed and va!id and Is affixed with· the lnlen\ lo be enforceable. I also certify that a ilght.oren1,y/encroachment egreernent hai,.beenforma!lz.ed between the well owner and property owner, if parties diffet.

PlintName:

ifo55 ~W~D'l/ Print Name:

The District has app ved the followi truc1Jon methods for tha well described in this permit:

"'f/., Pressure Grout Method (as outlined in Standaros)

Dall: / _/

t;,/713 y' .,

C ~NOT~ N881 cement is the only se.aling material aJ:IProved for p~egroutlng.

ff/J Drill OLII well to a lol:af deplh of 3 2. feet, with a minimum bore of ~ Inches. --~------□ Clean out well casing to a total depth of __ _ _______ feet and back ffll with approved sealing material Qf total depth Is

unknown, driller must determine total depth during clean out ofwelQ, NOTE: Neat cement is the only sealing material approved for back filling gravel packed wells. ·

□ Well casing must be perforated at the following depths prior to backfilr.ng:

□ Other.

Permit Ap;iroved ~

District Permil No.:

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F.C 191-fi~&-10) p~ go" '

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Ott~

·1-~2-~ ~10 ,4 Cllo:

The-QI!!~ t,n ~c.Jets 1ha lcillc)>,/lig desltUClfo'bmdh<fdsfotlh11welldts0tlbodln1hll pctrJnk: ~ ~wrt-Grou1,U,,1t,od•(•• OIJIVMd 1n $jllif~) . '(}(... 1'.QTE:~llkaal ttiml:nl l~'lhc Onl(&eatn,11 mllt1'!llll-a)>pro-,ed (orw~Ofll\lli/10, 'fi -Drlttcilllviellto~lol11l11ep~1of ~:? 'f~.wllh•mhiimumbolf>~ <l lnc:111>11. □ C1onnoU1watt ~nll lo• lollddoplh of , _ ,feel and ~11okfl(l wtl)j;ipp1oyad ■1mll)Q lllalllf~ (Jit~I d!_)pll, 11 u.nkn~ ~rlRlll;rnusl dolemiJlc·lolt¼)lel)lb ck)lln_o dean ou1•6j \I/Ill/), NOTE: Relllcoment ~a owt ii!'llll,iv mll!Mill ePPfOtoCI' for'bact,' 111ln3 (lrll\'!I plldi11d. wo1,. · · · 0 Wllli'OIIIP~ mu,a:I ~ PftlJlllll~ 111_ ll)ct~Yk,g.depll\J P1111r-\Q:ba~in11: ----,----~-::-:::-=--,---

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inov.na~ -'Clly,-Stalc,llp ~.s1.ie,~ C?:)',61.\110,Z\i .ll!1'!:'Pl9\ WAP.m6 - S111Jo1<,Ci.'.9Jllll ~:m:~-...CA.91l);) "l'osepl,01'6~,: • l'oltiMIID Ro~ ~.r--Pil0a!Hi;..~tWtil $111( ~.m)Q!t-a,~ iOa:Sll.l!QO. . ~ .w. ~ ~ P.-....l!I

AdclresT. ◄M57.w1~!11&1m~ c~ • .stai',z., i. o-ord:CA,-t~

W"-'~ll!IOopj:IC. 'rD!lllBo~~ 1-r -49.2'

Mll'Q~Oll'oo'ir. "'~""~~~-~ Adcfft.cs; 5SOR.l-:Ro>d e1,. $1oi.. 21p

• ·81o\!fll>, ~ PU71 T~hllc,b-N,,,; ~IS7 ~e-tlo.1 70'l.rltA300 7JOl1' _

Ca16. na!,m/,,10.1 ·• CU,tDOfbi llama: ;J);.~Si,11.

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".Q -~ 0-~TIMII -□ -~£:I~ o ·ou:n; -----~-=-_ ...... __ _

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R~~~~~~D .. _ ... ,.. \

s.c.v.w.o. WELLS

JOB COPY ~:1U·:·t· h.~ kep1 en t )I ·: !:. iit:" ..;t ,:-.;1 tu 1es.

Permit l\!o __ @,:i}()_~ _J--;)

•• •• ..1,f , , . ... , ... .. ~ ... . .. ... .,.

.. ·~ -

WELL D~STRUCT,oN APPUCATION ro 1eu10-.,o.1D)

l'BVC 3 ct'~

PfeAtie dt!erli/G [/idolaj~ t,M,~po~ ~menioa:(Anrvnlldl.Sl/UcllO!l¼whlt,li U>a /Dll~l119$i•ft111 pllee and IR.,,hlch lht\v~ bai, t flu,pod(()!Mldd 1.Mcabi!.~ , nf~l ~ dtri'o-)'118 wlng~\t~ na!I ~'11t'll1!10llll: >:i:ltccolnii:to'1111GUb>pu,o,p<4iA~~~l~&.~~lll01<1'dli>of<i?Co.ff\'e(Wi~·go,!odruf:iat.Allall,o~,li1ml foranlaimumoUO-i,;~,tl-"' IYm1on,,s~ 'l\ilt t.,i)!fo,j Ml\~ All dlipb:;od~,..(c, ,u11,:~tb••.,hnldc'9"ld O(No,'"'li'

The.l.litfrid hH' app«,vad~~ fo&-.•~119 d~l'I m111~d1.fof ~well d.t$C11~~1blf ~t 1 P1<m:u1e·Groul MeUmcf {es 00:Uried li,,S\inde11b} t) "K'cm;: N111al ~\ $ lfl<t Oil~ ~dng ITll\lemil'~~pi'u-Jlsj lot' ptc§U!il 1111l1i\vlg, d tf._ D/111 oul\•~H ID a iota! deplh of •3 7 _ _ feat, v1ltlra llllnlmum 1Mtt gf ___ _,;;0 ___ .._ lndie~.

O Ct••n;outwi.ll c:aiJtts la o lot,Jl/q')1l1ar. . 1e01~11d ~iH-ollvlllho~~,al"ltml1•'1ii 0ftol?l d"Pl!J rs . unlulcr,,mi dllllci ir,:u;t !loteonklc tolol depth d111lfigtle;il\6u'I of wall, NQll:: ~ camenl ii. Ilia o;iy f"..tint rr.lleri:al app;roved r-,, back· lilli~ 9tp\illl pJ>d;fd ,.,_,.,u~. · · 0 Wet! casing mµsll•I! pllrlorated all!iefcllowlna deplh_s pri(irfo badllilffl9:·.

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WELL DESTRUCTION APPUCATION • • f,:; l~li,O-U-,17!

Pt.11• •1 gf,:

t-- F'(~ compleltall lnfomraUDI\.

w..ii~r. ~~-w. 11Ja!lt0{/nbr'& 5b'lria ,!<iSdiu..-1835 ~,,-ll ·Lt,._~IOl

/\.roresi.'.-~0111:1'!/n ~-trl;hw">• C:lly, '$tale, Zlp c:-a./,C\°f.uJb ~ .

,P"!j)'l<ty"1Ml>U-. Sanf1Cll,aC.,.,;,y~&.Ai,po!ts:

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Cb)',S.1-.Zlp Iii! V-IJl.t. CUIS71 lt'bpllO!lo ~; C-~7 U-t-~: 1D1.J7U~ i 11»7'

t- All 9u~tlo1u; ~~-= to be·,;;ompli!t..d beforu pennltqn ht 1~$lled/ IJ unlt"°""'1 apprJ~nl ahall mllb on.on.ln>iii,stjg&llol\ IQ d~~lna oon<!Ct-o,:i=vter:a.: .

-Wa~~lltn~i 3,_ [ 5 ~<'Pe,~llwWdt,:i~ . . . ~a, r...- c~ ·v.y_ • -0~,~~4~!):" W.l Chl,,g tJi,,ia,~ '1c:blB!>li02 !)Qplh: )Yo1~0!anli:1v.

.. U.$' . US, • l' . Thl&J!11ell61> ~ .Bo,.Cotnp1,tiiJra, ,iui Morllqt11(9'\lkllr01 ~11r,llli'<......,7Wdb -c:o.....,tl~o.; ea,,.Mll';c tla,rq:

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R~~!!~l~D s.c.v.w.o.

WELLS

\JOB COPY .\ Mu~t be kepi on job siC?. at all times.

Permit No. ffe /}t)s:9-;)..

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V✓j::LL DESTRUCTION APPLICATtO-N ro !!>ii (1o.t6-iil)

!'.;ga 3 of:L ! :

Pi=d~i'l dc!l~ ihCJJlf~ ileslnr.$11 n1uUjO!f(l\,,iY.\~J ~frly.'fudi llie t!iaU c:u~·~iel\ ln'pal:e.;i~dlnwtacn ~»ell """B Q]., pad: ou(rJdA'l/w, ~ .p. ~i,e db'/oy~ ..,;\9 :.a,pwccl 1)0..; cN7\91'Jgr°'4: • • !~..,..o,:""'4-\~let•~•ifi-.tin1a!J,;....:ll~~:bp,-,,.11~•i.,fi,~t:,:ildwpucd,.._Mcr!!,;...;.r.1111:.usc1.{~.1.111!n:,r,...Cl0m!w'.u,~ '""''lhc ffc,tv,~ t.o Olk.4"1i!:b !":"""'._ .tJI ~=I sr~- "4?1 !u _,.,..i .,.,a,i;,p..:,;1 ~ ;

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C Vfdl e&P'lll ·must be perloralc,fal 1Mfoll:,i>1ng d~plhs ~ lo t,,d:fi11~; ________ ___ _

OOlher. gffl,+!914~-4€ 3£5- ~~-'2t

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Sonla Oare VcJley Waler Disbict6

5760 Almaden Expressway San Jose, CA 951 \l>-3686 (409) 265-2600

WELL DESTRUCTION APPUCATfON

~ Please complele all i11formalio11. OISTRlCTP~IT NO.:

l1tvo o 3 s

FC 198 (\0-16-10) Paga 1 or 4

Well Ow11er. Tn: Horou Group, Inc.

• Property Owner: I Proiruul• C,,rrido.- Joi:,t l'owo~ Board JI Name or Busines.s/Resldtnoe at Site:

_ Coltnin rnilroad tracks

Well 0...vnor's Ma.iring Address:

1835Barl:Joy Blvd.. Sulte IOI

Clly, Stala, Zip

Bellingham, WA 98226

Teli,phone No,:

3W.733.9029 >'.2756

Consullant

Cl\&l

Address:

~005 P«t Chica{lD Highw~•

City. State, Zip Concord, CA 94S20

Telephone No.:

92~.2£8.2274

Property Owner's Mailing Address: l 250 San Carles Ave

City, State, np Sllll Ou~ CA 9,1070

Teleph:1ne No.:

Drimr,g Compan},

- Addren of Woll Site: :-lonht.3sl of 1802 Higdoo A,•, on the oonh-.ASI sid> of th• rnib-oad tra::l<s

City. State, ZJp MounWo VicM·, CA 94043

Assessor's Parcel No. of Well Site :

Book lli Pago -'l2 Parcel flli

Woodward OrilllogComJ1111!Y, lne

Address:

S!iO Rivo- Ratd

City, Slate. Zip Rlc \rlSlli. CA 94S71

Telephone No.: 707 .374.430D

C57 Ucense No.: 710079

-=-------- -----------------If-::--------------'-- -···-- · .. ,. D Ched: ii address or phone number har. changed D Ched-, if address or phone number has changed •

► All questi om; below are to be completed before permit can be issued; if unknown, applicant shall make on-site investlgati 011 to

delennlne correct answers.

Well C;i,sing Depth:

(2.7' Total Boring D0plh:

<i.5' 11 Well Casing Diameter:

2"

This Seetlon tD Be Com1,1lullld tor All Mt>nltorlng Wells or Extraction/Recovery Welts

Case Name/No.:

Ouersl,;ihl Agenc;y:

J;PA

D Well on District property/easement (See General Cond~ion E.)

Well Description:

Casewor!<er N8me:

Pt. L)wS1>::t

CascwOflcerTelephone No.: 415 .792.314,

0 Vertlc:al Well O Dewalering Well O Elevator Shalt D lllluttiple Casing D Horizonlal Wall O Pit We~

Well Type (chec:r. aU the! apµly):

D Water Produdng O Contamination Cleanup O Agrr.JJl!ural O Domestic

(supply or extraction)

0 Vapor Extr.,ction ~ Monitoring O lm:Jinometer ~ Gro~r>dwaler

0 Piezometer D Interface D Suction Lysimetet D Se"tsmlc

0 Conlarninalic,n Cleanup O Reclaimed Water D Alr Sparging D Cathodic Protadlon

D Munl:ipal & Jndusmal

D Vadose

D lnjed\on/lnfit1ation

-~~!~~Jii&!i-•t~ Does the well have: 1.

2..

3,

Type of Original Drilling ~ethod:

Cable-Tool

outer conductor casing?

1'nnular cement seal olllside of casing al surface?

A S.C.V.W.D. v,aler meter attached?

0 Yes ~ No · -

t&l Yes O No

D Yes 181 No

i

t

-,i .~PR 2 3 201~0

S.C.V.W.D. WELLS

Sonla Clara Vallc1:1 Wal(?( Oisliic\6

57 !iO Al,nr1C~:, f:.qucs.~w3y Snn -ln~r.. CA !'!,\1C,3(.S6 l~OO) ~C!, ~{•G-0

WELL DESTRUCTION APPLICATION IC 108 C,C,I A,10)

l'~!)I! 3 014

Pft.l~I: d;..:;c1il>e ir, Jt,talf, ,;.;;; pr"f'uscd Je~lruction ~!h~d (Any 1ve'1idesl1\dkl·~·;;, which lhe well ~Ing is l~l\ in place,;~ 0

in~•;t11;:I;" the ~•elf· ha~ a fi!htr pack oulsli"fc! the ,...,.,,,,g. n1usl hr. de~troyOtl usi1-.g 11pprovet.1 nAfol cAml!nl grm:I):

:,.lr:.lj CC~l.11 g,ou: \\'i!I t,r pu:npr-..d into th~ -..,-.JJ ~q"l- SWlint rwn1 \RU ~Uo1c k; ,~ye, J'a:\.bdUYI. rJUUrtd Wrfi:LC.. Af1a lhc CC'ITKnlh~sel k°!-l ,,- minit.._u,n orJDn,;.,v:~ Ille ,...,.,RUil, HeGI will b: 011~..1 WU~ OOll<retc r\U dbpl11~d tJwnu .. 111c, llrfll !"-c,qxl1r...l "'"' di>4~1>al or1.,, •• ,1y.

~~}.~l~fil~:'.i:~Ic~~~~;1~~J0:,~1~1:~~~~~~!1f3m1'~ij~;(i~~~f'!f~~~i~~N];~~}f.~~Jffi~~~' .,,. ..... . ~Y•'II •,~ ~~,~,r.,,;w·"'"LC'-~ ~~'f~~l ~ .-: .~@.,.:rtg.:.~... . •~f.•'' L---~ .. J'7~~~ • •: ~ ~ .. :;u~ "" ...... &l~.b~~J

I unde1slar,d 1mti agree !hilt 1111 wnr~ u:;ocialcc! with lhls pcnnlt k; rcqulro(I lo bo done io occordanco.11.ith S3nla Clai3 Valley Water Oislrict (Dislncl) Well Ordinance f•0-1, 11,c, Oishicl Well Standards, and cond'!tioni of this permit (sea page ◄). I cellify that lhe lofonnalio,1 given in this pormil is correct to \ho bP.SI ol mv Jmowloc'su and th11l the si!JMlure b~low, wlltlthe, 01ioinal, ella!(..1ru111'c, 01 ph~to::oplcd, 1~ uuthor~oo and

valid, a":! Is llfli~e'1 with lhc 1rJijnl lo hll cnlorc:ooblc. I :ilso 001Ufy lhal :i right of enlryfancroacllmenl aoreem!!flt hc1~ lll!t!fl ftln11a!ized belw&All ti•~ wc:11 own~r and prop~rt)· o>'tTle,, ii p011iU3 dlffct. ., ·-·--- - ____ . .._ ____ _

, Print ~3rr.c:

,Wiss Ufitfll~IV s~~~~\.ltC c,f Proporyy o ... VH'511/f,y-e.:al

t,,Af M - 1Vly-- ·

s,~n.-1v,c ol unflo1//\9or.1:

------+-F>-•~_1

N_~p-117~_'",..z _ tx-_·_~_,_r/1_:+;J Vr',n: Name:

lli1, l)i~lfr:t ha& ar,rirnw,i! 1hr, ir,l'o.•1in~ OP.Gtluciion meH10ds IOr lhe well described in !his pe11nit

')l! l'rcn:ourc Grout Mnll'll'>CI (or. cuUrnod it> \;lar,n11rd~) NOTE: Neal cemen\ s the CMly sealing ni.:ilerilil ap;irovt!d (or prcssu,c grouling.

JI. Drill o;.,I wcli toe tot11I deplri of _!:IJ:_'.. S" feet, ,,.,;lh II minimum hrm, of 8

• 1)3111: ~ /

I .. ( ~?_-i_:':f _ _ , Deto:

1 / 1 I IY--

lJ Cl'lan oof well cesir,g lo ;i 101,,1 l!e11111 ~, ·--------- Im:! ~o-1 hRr.lo. 1111 "'1111 nppmllCd sr.nhn11 mot<!lilll (ti tolal depth,~

unkoown, dr111or mu~\ ctP.fermire fola1 llcpth d1,11ing de.-, out ofwP.11). NO IF-:: Neal r.emenl ls the on~• scaling material approved for b1tcl<

ll~ino Qlll\lfll PBCkC<I \YCIIS ,

w VIP.ft =~Ing mu~l ht: pP.rfor~,c~ nt 1hr. foU""""II dnpthr. pri01 to backlilll"9:

D Olhcr:

------- - ·-----.-- --- - ---::::.::::::::::::::::::.::::_--.. -·. --- -~~m A, -zju,~

l"j{JCJ03S'f10:,J~ltn'l, 1 /'f

. -·---·---·-·-1 °~Y 2 7 / '-/ --r---n ____ .. _ o,rn.,-"'i3of!J2.// Z G /

Santa Oa,a Volley Woler Disttic!o

5750 Almaden Expressway San Jos .. , CA 95116·3686 (408) 26!'>-2600

WELL DESTRUCTION APPLICATION FC 1!18 (10.18-10)

Pa~ 1 of~

► Please complete all information. OJSTRJCT PERM~ 'tj·po c) 3 .S-3 Wall Owner: Property Owner: 1 Name of Business/Residence al Sile:

Th~Homl>J<Group,lr.o, (P-:nif\fvl forr ·J~ .. :~ ;'\i,- ' l.,Jt/}B,:..,,, Galtruil'I .Rc.,l tt.~,, t~<c...k..-,.~""'-----Wall O.vner's Mailing Address: I Pr~p~rty Owner's M. ,ailing Acldress: Address of Well Sito:

JS35 l'3orl:JcyBh•d,, Suite J(II 'l.!.1.,' ~<i'l (vdas /tv'l. \Ol (.:u;+;v > ~ City. Stele, Zip City, Stale, Z:ip City, State, Zip

_·n_c_m_nB~ll_wi_,_,_v._ .. _98_2_2_6 _ ________ .s"" (llr"la,s., cA ~ '--\.~·~o~ ----i·-M_o_un_lB_~_,_'i_c"_',_C_A_!'i~"1_V_~~-------Talephone No. : TelephOne No.: A&sessol't. Parcel No. of Woll Sile:

360.733.902~ lt.'.2.7S6 j Book ~ Page .Q2

Consunant I Drilling C~any:

CB&l Wood .. 'Bnl Drillin,r. CcmpMy, Inc

Address: Address:

4005 Port Chio11gr, Higlnny

Ci1y, Stele, Zip Concord, CA 94520

Tclephon& No.:

925.1.88.2274

550 Ri,·cr Rood

City, State, Zip Rio v,,a. CA94571

Telephone No.: 707_,74.,:300

C-57 Ucans,", No .•

710079

D Che~ II adores~ or pnone number has ch:ingad 0 Check H i!ddtess or phone number has changecf

Parcel 001

► All questions below are to be completed beforo pennit can be issued; if unknown, applicant shall make on-site investigation to

determine correct answers.

Well Re;iistrat/on No.: Owfier/Coll5Ullanl Well No.:

--~t:k_So;;i._1,vJ...1 ~o"'-=o'""S-~---,'-v_-s _ __________ --=-_ ___.,__,_-=---=--'-=-=---- - ----wa" C11sing Depth: I Tolel Boril\g Depth:

36.S • 40.S

This Section to Be Completed for All Monitoring Welts or Extnictlon/Recovery Wells

Case Name/No.:

Oven.igh\ Agency:

iiPA

D Well on Dlstrici property/easem11nl (See General Cr;mdition E.}

Well Desc:.riptJon·

I• Casewoiker Name:

Di. lylll\ Suct

I Caseworker Telephone No.:

~15.791.3148

:is! Vertical Well O Dewalenng Well O Elevator Shall O Mulliple Casing O Harizoolal WaU O Pi1 Wek


D Water Produ~ing O Contamination Cleanup D Agricultural D Domeslb

(supply or extraction}

D Municipal & Industrial

D Vapor E.xttactic,n ® Monaorin9 0 lnelinooielet [gi Groundwater D Vadose

D Piezomeler O lnlerface D Suction Lyslmeter O Seismic D lnjeciion/lnffllratlon

D Contamination Cleanup O Reclaimed Water . 0 Air Spaiping .. 0 CathocliG Prolection

-~~MitB~~~ Does the well have: 1. Outer cond\l!:tor easing? 0 Yes [gi No

2. Annular cement seal outs·ld~ or casing at surface? l8! Yes D No

3. A S.C.V.W.D. waterrneter attached? D Yes 181 No

Type of Ori9lnal Drilling Method:

RECEIVED APR 2 3 2014

S.C.V.W.D. WELLS

of<.

51"0 Al•1,;.rle,a l'-"fltC'-s"·ay Snn ,IDr.r. . Cl\ !1~110-3C.SG (.COO} :.?&!.. .?C•OO


- - - -- . ----·-·---------- -

IC 108110·1 A-10) P3gc 3 ol ~

Pli,.asc: de.sc,iln, in de.1ait, Iha fl(\ lfl ..,sl!d tle$fructicn rnelhod (Any wt'II cfosln.•clic,n In which the well casing is l!!fl in plat:Q 1111d In whir.h the v,efl ilM. .n f\llor µ~ck outJltlt: llu, ca~-ln9. must bP. Cfe1,lroyed usi11y 11r,proved ne;,,1 cP.ment grm:t):

~ul oc:m:111 i;,0<I\ "'\U tir pu:npcd i1110 1ll t ,.,,.JI ....... ~swllot r,11,.,1,,;11 i.,~ ... 1c r,T. r...,, ~.i ..... g,uund ..irtu ... Alla the «>n<nl hus:: ii,, A rr,inimu,11 ollD m,11,:c,,, ~

rcn>ilnint) I«! wlh bo l\llc..d 'llh <®ctCl~ AU dhplofcd r,,IXIIKl\lWCI ,.Iii !"' <41, .,cJ .. 111 Ji-t•n.cJ 11f 1••~r,1ly.

~f.~r~wii:~~~~~lf~~-lt,~w.~~~~m.~~~~½:1W~~~w~~~~~~~&~~~ I understand and :iorcc thal ell wor~ assoclalcd 11:~h thl~ pcrtnit 1G ri-qulrcd lo bo dono in occo.-donco v.ith S3nla Clau:i VaHey Willer District I (Pi~lrifl) Well Cl'rdlnance 9"0·1, U,t- Ols11ictWeU Slandaids. 11ncl c.o11<1ltioni ol lhis permit (seii pege 4). I certify that L'l& intommtion given In this pcnnll (s corroci to ltn.1 t>u&I ot 111v l<nowJoi.';n ard !hal Ille s:9--iatum below, wh!!lhet 01igin~I, el1M.1wn,c, ut photocuple<I, I~ au1tiu11zed end

vllll6, o~ Is elti~cl1 with tho ,r~anl lo he t:nCorco.:ible. I also ~rtlfy lhal ::. righl of entr,•/enc,o~c:hmcnl aarecment has llut.'n formalized belw11en 1

Uu, wt:ll oWllnr »ntl prop"rty OW11~r. ii portio~ r11ffor. -·····- --·-- ··---·- .. ·-------.- -------1 s,9n&Moo!WIID~----0....t....,A- , P,7#~~ U/JtJl_'0I//

1

. ~at; •(?··?·f

_s1-~~~~~~~,:~~~~~-~•~:••1iv~- ,_. ______ _,l_P_"f>._"1_N_~~E~i'/N7 l~_;.;_ ,,,_v1_.·~_-J_ .. __ ~ ; / lj / !'f-

l Vf,n; N:111,e:

_ i:. · I ? .. i~J ····--o~,t~

n,r, l)istrr.-:t ha~ arpmvP.d 1hr, fol 'owirig dP.sllucfon rnclhods lor the well described In lhis p,!llnit:

~ flr~"surc 0 10111 Mn:hod (oe oull•ooef ill Slandi16a) . NOTE: Na:il oet'!\Cfll fs the o:,1)1 Gt!;tl,n~ malen11l 3p;:fOVcd br pressure QfO\Jling.

)( Dri!J ot.rl well toe \olsl deplh of _':/..!!.~_':)"------- leet. 1,,ilh a minimum born of _____ g;._ _ _ _ Inches.

0 Clean ool welt ca Sill!) II> n lot;.J c'c11th of _________ II!,:( an.1 h:-t,J. 1111 wilb ;ippn,vod sr.nknll motc/llll (11 tor,11 deplh •~

unknown, driller mutl delermirc 1ota1 depth rluring del'li olll olwtll), NO If.: Ni,at cemenl is the onl1• scafin; ma1ellal approved for ha~

tUino gravel p11ckcd wells.

n Vic¥. ca.,ing mur.l h~ perfr,r.,tc., nt lhc lollDWi,,g daplhR pno, lo backfilli"!):

□ Other.

. -- - -·--- ----------·-- - ----- ------- -- - ---------- -·----- -··. -------------

:>cm,":! /lpproYed by:

Santa Clora VoDe!:J Waler Dis~i,() 5750 Almaden Expressway

Sim Jose, CA 95115-3686 (408) 265-2600

WELL DESTRUCTION APPLICATION FC 198 (10-~6--10)

Page 1 of 4

► Please complete all lnformation. DISTRICT p,~f5 OD% .3 Well Owner:

The Homme C'rmup, Inc.

Well Owner's Mailing A:ldress; !&35 Oar1.:ley Blvd., Suitr 101

City, State, Zip

BcTiinglulffl, WA 98226

Telephone No.:

'.160.733.9029x2751i

Consultant: CB&.T

Addr8$S: 400:i Port Chic»go Highway City, State, Zip

Concord, CA 94520

Telephone No.:

9ZS.2882274

0 Check if address or phone number has changed

Proparty Owner.HM. Anthony Marital Doduclion Trust, Name of Buslness/Reildence at Site: Carol Jean Anthony, Trui!ee Fonner Iiuco Chi:mical Corpollll.ioo

Propert,, Ownal's Mailing Address: Address of Wall Site; 331 CyPJW Point Dr. 1710VdlaSt

City, Slate, Zip City, State, Zip

Mountain View, CA 94043 Mountain View, CA 94041

Telept1e1ne No,: Assessor's Parcel No. or Well Site:

650.961 0207 Book ill Paga ll2.

[ Drilnng Company: Woodward Dn11Jne, ('~ny, Inc I Address: SSORivcr~ Ctty, Slate, Zip

Rio Visa, CA 9~ 57 I

Telephone No.: 707.374.4300

C-57 Ucense No.: ?1007!1

D Check II address or phone number has changed

Parcel lll!1

► All questions below are to be completed before pennlt can be issued: if unknown, applicant shall make on-site investigation to detennine correct answers.

Welt fteglstraUon No.: Owner/Consultant Well No.: · , so::iw;21FooI V-4 --- - -b ...... ~~------'--"---1

Well Casing eplh: Total Boring De:pth: JS ~ •

Well Casing Diameter. 4•

- ~ -~ to B_e ~':!'1plomd for All Monlt.ortno Wells Dl'.ExtracllonlRecovery Wells

Case, Nama/No.: I Caseworker Neme: . Dr. L)llD Suer

Oversight Agency; EPA 0 Well on Dlslrict pro:,erty/easemenl (See Gallelill Condilitlf't E.)

Well Des~rtplion:

j Caseworker Teleptone No.: 41S.i92Jl48

1'81 \/ert1cal Well O Dewatering Wall O Elevator Shaft D Multlple C&slng D Hora:onta WaM D Pit Welt

Well Type (check all tl-.at apply):

181 Waler Producing O Contamination Cl11■nup [&upply or extraction)

0 Vapor Extraction

0 Plezometer


Does the well have:

0 Monitoring

D Interlace

D Reclaimed Water

, • Outer conductor cul rig?

0 Agricultural

D lncllnometar D Suction Lyslmeter

0 Air Spargill9

2. Annular cement seal cldslde o! casing at&Urface?

3. A 5.C.V.W.O. water meter attached?

Type of Original Drilllng Method:

0 f{clary □ Cable-Tool O Hand-Dug PltWeU [81 Hollow Stern Auger

D Domestic

!isl Groundwater

0 S11ismic

D Calhodic Protection

0 Yes r8I Yes

0 Yiis

0 Olli&r:

181 No

0 No 181 No

D MuniC\'.lal & Industrial

0 Vlldose D Jrijectlon/lnli\lratlon

IMPORTANT . A rninirnu1n 24-hou, 11011cc rnust tc rnvC>n tu S.:i, ,t, Cl ,n,, V;illc:r Vliatcr D,t.lr1ct prior to rnstalling thr: .rnr 1t.dar sc;il

C.ill (408) 265-2607 r.xl 2E,G() Please Jllow 10 work1119 Lhsy,o to f"occ;ss pc;rm1t ;,µpl,c:itmn

.i.,0 ~- ----.. ~11• - ···

l. ' I

._ ,, . ,.

~ l l '

Santa Cloto VaHey Wale, Dis~icto

5750 Almade11 EJcpresswa~ Sall ~os~. CA 95118-3606 (408) :?65'-2600

WELL DESTRUCTION APPLICATION FC 19!1 (10-18-iO)

Page 3 af 4

--------------------------------------------Pleil!ie describe in detail, the prop051i'd destNc!ion method (Any well destruction In which the well casing is left in place and 1;, which tho wcU has a filter pack outside the casing, must be destroyed using approved neat cement grout) Nclll cc:mc:nt gro!JI will be ;,umped into 1bc well casing stlll".ing from weU hottom 10 fi\'c fed below gJ1>U11d surface. Afu:,- the cement has set for a minimum o{ 30 min~. the remainillg 5 feet will t:,c fl lied with concnru:. All displaced gruu11dwa:cr "111 be captnred and disposed of property.

I understand and agree that all work associated with this permit is required ta be don1:: in accordance with Santa Clara Valley Water District (Dislrict) Well Ordinance 90-1, the Dislrlct Well Standards, and conditions of this permit (see page 4). I certify that the information given in this permit is coJTect to the best of my knowledge and tnat the signature below, whether original, electronic, or photocopied. is authorized and valid, and is affixed w,th the Intent to be enforceable. I also certify that a right of entry/encroachment agreement has•been formalized between the well owner and pr-:>perty owner, rf parties differ.

The District has ap ed the following rucoon methods for the well descnbed in this permit: ¥ Pressure Grout Melhod (as outlined in Standards) NOTE: NOt~menl is the only sealing material approved for pressu_re grouUng.

'r- Dr!II out well to a total depth of '3 ~ feet, with a mlnlrnum bore of ,,. / D Inches.

□ Clean out well casing to a total depth o_f _________ feet and back fill with approved sealing material (ff total depth Is unknown, driller must determine iota! depth during clean out of well). NOTE: Neat cement Is u,e only sealing metartal approveci for baei< fllfing gravel packed wells.

□ Wen casing inusl be perforated at tha following depths prior to backfilling:

0 Other:

Permit Approvod by; A. Dato:

1;2_/11/13

Sanlo Gora VaR!:>y Wole, Disbk()

5750 AiTiaden Expressway Son Jose, CA 95118-3686 (IIOB) 265-2600


Paga 1 of4

► Please complete all infonnalion. OISTRICT PERi: NO~ _(o t/ 3D0D5 Well Owner: Prope,tr Owner: H.M Anlhony MMital Deduction Trust, Name cf Business/Residence al Site: Toe Homwc Group, Inc. Carol Jean Anlhony, Trustee I Former Josco Clnmic:il Co,por'lltion Well Owner's Mailing Ac dress: Property OWner's Malling Address: ; Address or wen Site: 183~ BKrkJGl' Bl"d., Sui1e 101 33 I CyprC55 Point D1. 1710 Villa St City, Stale, Zip City, St2te, Zip Chy, S1a1e, Zip Bellingham, WA 9&226 MuUDllti.11 Vi=, CA 94043 Mountain View, CA 9404 I

Telephone No.: Telephone No.: Assesso~i. P.ircel No. of Wall SIiia: 360. 733.9029 x2756 i 650.961.0207 Book~ Pagi, ~ Parcel QIU

Consultant Dnmng Company. cn&r Woodward Drilling Complln)', In~ Address: Address: •1005 l'or1.CbicagCI HigbW3Y 550 River Road

City, State. Zip C~y. State, Zjp Conrord. CA 94520 Rio \'iSla, 0.. 94571 Telephone No.: 'felephone No.: I C-57 Lfcense No.: 925.2.81!.2274 707 374.4300 710079

0 Check if address or ,:>hone number h115 changed 0 Check If address or phone number ha5 changed

► All quHtions below are to be c.ompleted before pennit cao be lssulld; If unknown, appllc.antshall make on-site investigation to detennlne correct answers:.

Well Casing Depth: 48'

This Section ta Be Complt!ll!.d for All Monitoring Wells ot Extr.iction/Recoval) Walls

Case Name/No.: I Caseworker Name: Di. Lynn Suer

Oversight Agency; EPA 0 Well on District. property/easement (See General Comfrticn E;) Wall De!lcrfptlon:

Caseworke, Teleph1>ne No.: 4~5.792.3148

l!Sl Vertlcal Well □ Dewatering Well tJ Elevator Shalt D Multlpla casin~ D Horizontal Wall D Pit Well Well Type (check all tt,e.t apply):

0 Waler Producing O Contamination Cleanup D Agricultural O Domestic (supply or extraction)

O Vapor Extraction

0 Piezometer

0 Conlilminatian Clea:,up

Does the wall have:

181 Monilorir,g

0 lnlerf:lce

0 Reclaimed Water

I . Outer conductor Cll5ing?

0 Inclinometer

D Suction Lysimeler

D Air Sparglng

2. Ann~ar cement seal outside of casing at surface? 3, A S.C.V.W.O. watermek!ratteched?


0 Rotary 0 Cable-Tool 0 Hand-Dug Pit Wen [Bl Hollow Stem Auger

181 Grotmdwalsr

D Seismic

0 Cathodic Prolection

D Vi!S

l8l Yl!!S

0 Yes

D Other.

l8J No

D No

ll?J No

0 Municipal & Industrial

0 Vadose

D lnjtct1011/lnflllration

IMPORTANT A mI111mum 24-hou, nol\cc must b£' given to Santa Ciara Valle, Wat:;r District pnor lo m~t;,11,ng the annul;.ar se;,I · Call (40S) 265-260,. l!Xl. 2660 . Please c1llo\'/ 10 working days to pror.c~s pcnrnt .:ipplIc.:it1on.

:r ... ··-~~,. ... ,...._. ..... ;,..r. _____ ....... . . ,r, ,,

Sonia Clara Vollet:1 Waler District()

S7S:l Am,adcn Expressway SM ,loie, CA 951 18-3888 t.tOBl 2&5-260.0


Page ;3 of 4

------------------- - ---- ------------------------. Pl~ase desc:.ribe in derail, the proposed deStruction met,od {Any well destruction in which the well casing is left in place and in which the well has a filter pack outside the casing, must be destroyed using approved neat cement grout): Neat cement grow will be pump-..d into the well casing startiog from ..,,-ell b;,11on1 IO five fcc:r brJow ground surtuc. After the cement has set for a minimum of 30 mio~tcS. the remaining S feet will be filled with ooncrc\e, All displaced groWldv.'Blcr will be captured 1IOd diS)IOSCd of propcriy.

I understand and agree that all wol1< associated with this pennit I& required to be done in accordance with Santa Clara Valley Water District (District) Well Ordinance 90-1, the District Well Standards, and conditions of this permit (see page 4). I certify that the Information given In this permit is correct to the best of my knowledge and that the signatura below, whether original, electronic, or photocopied, is authorized and valid, and is affixed wlth the inlenl to be enforceable. I also certify that a right of entry/encroachment agreement has been formalized between the well owner and property owner, if parties differ. -------------------------,-----------! Signal!Jre of Well ~~--- -~1-p..:..~...!..N=--;;=---~__J,~~~~ 9:....v_lll ___ +I-Oa-le+-: _1/..,.t.~:__· _?==-3--l Signature of Property Owner/Agent: Print Name: Date:

(!_/ifef)J_ JeAAI -~ . 7~ IJ Print Name:

.e:=• ,_•~_\._.\..,_('...;;•._,'i.:.,' ~j'---'\,___.\_._1~ .'.:....:l 'r._.\'..:.:: .,_,1'J""4,"""-&\"-',,.._\_.(_~.,.._-----~➔~\\il\U. I 'f. Signature of Con~'u~anl/Agi!nl (if any): P1irll Name:·· ~ ·

~" «'~b->\"-4.... • • 1{~ -- (:

The District has approved the following destruction methods for the well de.scribed In this perm

"-,( Pressure Grout Method (as outlined 1n Standards)

Dale:

v. ~1n,·c\v:.~Rd. __ \?...:.-\ S-= 1 -) Date:

I\ (1..\ 'I:)

NOTE: Nea~c~ent is the orily sealing material approved for pressure grouting.

f Drill out well to a total depth of 'i ~ f85t, with a minimum bore of -~--------- Inches.

□ Clean out well casing lo a total depth of _________ feet and back f~I with approved sealing material (If total depth Is unknown, driller must detj!nnina tol al depth during dean out of we IQ. NOTE: Neat cement is the only sealing material approved fer back filling gravel packed wens.

□ Well casing must be perforated at the rollowlng depths prior to backfiUlng:

□ Other:

Permit Approved by:

District Permit No.:

Sanla Oare Valley Woler D;sujc()

57b0 Nmadcn Ex;re$SIVJ.Y Snn Jo:,o, CA 9S 11 6·368.ij (-408) 265-2600

WELL DESTRUCTION APPLICATION FC 198 (10-1&-10)

Page 1 of 4

► Please complete au information. DISTRICT PERMIT NOj Lf /7 Q 0 3~ Well owner. Property Owner. Name of Buslr1es$/Residence al Site:

Th~ HOilli!X Group, Inc. PeninsulaComdor Joint Powers Board Caltrain raHioa.d ltacks

wen ON!le(s Mailing Address: Property OWner's Malling Address: Address of Well Site: lr/0 t)," IUS Barl.:l~• Blvd., SuiU !OJ 250 S;w C'.ados An ~ /}~~

City, Slate, Zip City, State, Zip City, Stale, Zip

Bellingham, WA 98226 San Carlos, CA 94070 Moum.aln Vic:w, CA 94(143

Telephone No.: Telephone No.: Assessors PBroel No. (l! Well Site:

J60,i.l3.9029 li1.7S6 Boo~ J..H Pa;I' Qi Parcel Ql1

Consu~ant. CB&l

Address: 4O0S Pori Chicago Hig.hv.11y

Clly, Stale, Zip. Conco,d, CA 94520

Telephone No.: 92S..28S.2274

I Dr111,ng Company.

Woodw,u-d Drilling ~ J'SII)', Inc

Address: 550 River Road

City, Stale, Zip ~o Vist2, CA 94571

! Telophona No.; 707 374.4300

C-57 Lloense No.: 710079

D Check If a~drus 01 phono numbet has changed D Ched< if address or phone ni.mber has chan{led

► All questions below are to be completed before peITnit can be issued; If unknown, applicant shall make on-$lle lnvestlgallon to deteITnlne correct answers.

Well Registration No.: Owner/Consultanl Well No.:

Olt:>,":JoJ-i..; J-1 f.l'' P-SP

Well Casing De;:,th:

21' Total Bolin;i Depth: 21'

Well Casing Dlameler. 2'

This Section ID Be Complel!td for All Monitoring Welb or Exlnrnlior\/Recovery Wc:lls

Case Name/No.: I Cesewolke1 Name: Dr. 1)1"1 Suer

Overs19hl Agen;;y; EPA D Woll on Di~trlcl propertyJeasemBnt ISee General Condition E.)

Well Description:

Caseworker Telephone No.: 41.5.792.3146

[&I Vertical WeU O Dewatertng We" 0 Elevator Shaft O Mullip!e Casing O HorizDnlal Wa" 0 Pil Well

Well Typa (chack all thal apply):.

0 Waler Producing O Conlaminatlon Cleanup (supply or eXlraciion)

0 Vapor Exltaclion

@ Piezometer

0 Mon~oring

0 Interlace

0 Agri::ullura i'

D lnciinometer

D Suction Ly6meler

0 Conlaminalion Cle;,r,up D Reclaimed Waler D Alt Sparglng

D Domestic

181 Groundwater

D Seismic

D Cathodic Protection

.0 Munic(oal & Industrial

D Vadose

D lnjed\ont1nfiltralion EM!i-~-~~!ii~-Does lhewell have: 1.

2.

3.


Outer conductor caslr,g7

Annular cement se.11 outside of casing at surface?

A S.C.V.W.O. waler meter eltached?

0 Rota')' 0 Cab~Tocl O Hand-Dug Pit Well t1!'!i Hollow Stem Auger

□ Yes ~ No

[is) Yes D No

0 Yes [isl No

D other.

IMPORTANT: A minimum 24•hour notice must be given to Santa Cl.ir.-:i Valley Water District prior to instaJllng the annular seal. Call 1408) 265-2607, ext. 2660. Please allow 10 working days to process permit application.

s.c.v.w.o . . WELLS

yl I I

ti~ SJ-!

' ' '

Sarf.a CiOJo ~tJ Wclec Di~Jic(O 575:l ,\h;,.:en E·,p;cJi~-.r

£an .I::~. CA li'Sl15-':l£.56 ,~0~1 U,5-2«!0


i

re ,ea (IO--l e- 101 p~:)~◄

·;;;ea~ d Ct>c.rlJ,q in d~Sll, 11'1!1 pr~pa=<J du;;t,vcl.:n, n -~'°;l'lf"'t =U tb.if\1,:ll,:.njn ,men lnll wcU t:11:-it-9 h left In pl6e~ .-rd;,, w!->ccl, tho; wall

11:.s a filler µ:acttcu1s1do U1e =m9, IT\lfst ba das~tfG:!1 i..-,•19 e11;>fOftd ~al a:mc:nl S(OV:): •

»-..1: u,,w1: p:,.,, ~ftl ~: r~1:.1<=1 !I,:,;,~ w:.11 C'.ltrt1: ~-;•f.lre<Oml)l..>!lce!I ID fi~~= l<:!t~·s::om~..l!CO,.•.ilc, lh, ..n<;11h,.t~l K~ tmi.11:r.=~Dl• . ..-.b:r,;. Ii><:

,rcr1u1nu1cc f:ct ''f tr.: ,u.-., 1>fQ1 , te1t.. ,'Ill !\1'),J,r<t i;,ni,>_,.•.,ic, •·ill l•4<J1-ii:.1tt..iit>c! C!i>t"'"'' llil•Wdl>·

....... t ..... \ _ _____ ._\,ef'~l(\ I\ - •· t,1 1'-, ... r\1:·•ofr

14;~ .b£[AJ A~JA

------'8 ____ lllChe,!i.

0 Clea~ c.il ,~cA C-3:sin~ ti;, a total depth of _ _____ (i!Bt and ll3cf; llil _wllh .epp;v.•"1Mmil1>;in1nl1:1ial Qf tolllld!?pCh is

11nkn:1>tn, f~llil mu&ldlil.,,nnin<: tot a.I deplt\ duriilg di!lln P'..rt ol WETI). NOTE: Naal CQme..if jg !ho only S"..allil~ 11\jal!Hlal appm11ed for ba~

filli11;, gro-. .I packi;:d wells.

0 Well OtSl~ must b~ J,erlo.--Mr,d i,\ !lie follo'lling depths nri¢r lo haci:nlir,g: i

□ O\J1(!r: r J _ _____________ _ I

- - - - .L~-------- - -::..-:..-_-_-_-_-_-----... -._-... -._-~---_:-_-_-_-_ -_-_-_-_ -_ -_-_-_-_ -_ -_:-_ -----...=--:::::::::::::::::::::::--l ?o.m~~.~-t~~· ~ //, ~ 10;;-fpy

I

fJal.l! i;,~v..-t1 I St,,, '-1 ....

San~o Clara Volley Viole,~

5750 Afnaden Expressw;iy San Jose, CA 9511 B-3696 (406) 265-2600


Pagel of 4

.. Please =mple1e all information . DISTRICT PERMIT ND.:

iJ.t(?oo3t;'.,3 WellOWner: Property Owner. Name ol Business/Residence at S~e: The Homu Group, Inc. l'cnin5ula Cmridor Joint Powers Board CaJtraio railroad !nlcb

Well OWne!'s Melling Address: P1openy Owner's Malling Add1ess: Address of Well Site: rtJ2P-.lu < I if l83S B!akit)' Blvd., Suite 101 250 SllD Oirlos /we ~ • lr/0 ,;, A-

City, State, Zip Cit)', Sta\o, Zip City, Slate, Zip BeUingham, WA 9S"IJ6 San Ou1o5, CA 94070 Mountain V3c:w, CA 94043

Telephcme No.: Telephone No.: Assessor's Parcel No. of Well Sita:

360.?33.9029 x2756 Book ~ Page !!:! Parcel !Ill Consullant: Drilling Company: CB&J Wi;,od,..wd Drilling CompMy, Inc

- -· Address: Address: ~oos Port Oiicago JflgbW~)' S SO River Rood

Cit)•, Stata, Zip CUy, Stale, Zip Contwd, CA 9452(1 Rio Vistr., CA 94571

T!:lephone Na.: Telephone No.: I C-57 License No.: .925 .288.1274 707 J74.4300 710079

0 Chea if address 01 r,htllle number has cl1sn98d D Che~ if addres.s or phcr,e number ha$ changed

1-- All questions below nre to be completed before permit can be issued; If unknown, applicant shall make on-site investigation to determine correct answer.;.

" Well Registration No.: Owner/Consoltanl Well Na.:

O <,:,f:,O;;L W ;;t, rO ·--1.. - P-Sl!

Well Casing Depth: 6S'

Total Boring Depth: 70'

Well Ca:,ing Oiameler.

This Soclion to Be Compll!ted lor ~II Monitoring Wells or Extraclion1Reeo1111,y Well:,

Case Name/No.: Casewo~~er Name:

Dr_ Lj,onn S Utt

Oversight Agency: E:'A

Caseworic.er,elephane No.:

415.792-314S

D Wefl on District properfy/easemenl (See Gene:-al Condition E,)

W1tll Description:

~ Vertical Well D Dev.o;iterin9 Well D Elevator Shaft O Multiple Casing O Horizontal Wi,11 D P~ WeH


D Water Producing D Cont:imioatlon Cle,mu~ D Agriculluml D Domestic (suppl)' or extraction)

D Vapor Extraclion D Monitari:'IQ D Inclinometer

~ Pi9iomel!:r D Interface D Sucli~ Lysimeter

D Coi'\la.mination Cleanup O Reclaimed Water D Air Spar9in9

~ Groundwater

D Seismic

D Cathodic Proleciion

D Municipal & ln~ustrial

D Vadose

D lnje'dionllnfi~raUon

-~~~~-Does the well have: ,. 2.

3.

Type or Original Drilling Method:

Ouler condoctor casing?

Annular cement seal oulside of casing el surface?

A S.C.V.W.D. water meler att11r.hed7

0 Rotary O Cable-Tool O Hand-Dug Pij \o\leli ~ Hollow Stem Auger

~ Yes O No

18! Ye$ 0 No

0 Yes ~ No

0 Other:

IMPORTANT: A minimum 24-hour notice mus1 be given to Santa Clara Valley Water District prlor to installing the annul;ir seal. Call 1408) 265-2607, exL 2660. Please allow 10 working dilys to process permit application .

S.C.V.W.D. WELLS

, , ,·

!. 1,

-

S7f,0 Ai-n.,,;irs1 D?rc._~1,·o~

San Jo1u, CA s~11 e-JSBS !40SI 2~S-2SOC

WELL DESTRUCTION APPUCATION fC \~3(1rr!1MJ}

f"iiiJI; 3 ,,: <-

~~~ L~0

<'tlllll. 1l11! propost)d d~rucL'o11 rn()thM (Any well destructlon In wr-,lr.r, ll\e wc,1 @Slr,g Is .;;;;-In pla~ anj ~1 1·,tdch the ":~, - )

h,s. ,. rrtt~ i,~di 011l!1\de th(, =ing, milt\ bt des"utr/.;<I c~r,g Dpp1t111l!d nc:at rem!!l1f (li'o!.11).

"~ ="' ""' """ ""'"',.. '"•",~a,=<••'=""''="•~"'..,.,,,.,_, __ ,,.""~•"'•~~'"•..-•• ".,,-.• , J <oaom,,, '"'"1k<=~• •=<~~_,,~-.,.,a,- ~Ok..-,~.,,_.,,-~.-,,

.~~~~~~~~~~~~~~-!~~.,: :,,:"' :. ,.~~w~:, l 1.mder~1B.'l:l :..~'-11 all "-:,ik, i,.z~:)afc;:d'\'.ilh ft,;':; p<:onll ~ lDquitn:$ lo~ d~l'l<l Li' ~iln~e 1\'IUI Sll/ll.,. Clue \lall~y ~~ler oi•,lri t;I'

(Oislri::t) Wall 0,rll!nc1l'lro ao.1, lhs' Oi,.vi::;1.Wcll SJM;ianb. h~iJ cooaalons_ol lhl~ r,e1mcl (; p::y:, 4}, I willy 1h01ls\!lintormntio119~i,n In u~s

peimn ,~ o~a&q: 10 me bes( u r "')' k1:.01•11~31e mrtl U;:11 11 .. -sf9rn-.:h11t bnkt,v, ~411•ll•ct oHtJlmd, i:J~tdc, c, plu,>!oo,p,il, Ii- n,lli>ortie4 :tNI

~aiic:t .;rid ii. ,:!({JI~ 11.ilh the lnli,,.11 fp l>O t:(lfon;e~. I !ilSo Cll!t'l)• lh111 11 rlghl o l entrr/cnu,,i,chnic<11 at1rocritMI t.ss !>(:en fe>:rrelra:d b:ll-t1~1,

_U-~Cl,'!!!;W ?l\d prgptl~y 01•,ner, .u ear1!~.:' dlfiat. S1?Slll!MOTW - • ,_,,l!Jt: ------- ---,,-;,i;;;;-- -- •- -•

: ... . slgr.alLII ol Pt<>~l'<I>' Ovin;ll'A~9~l:

: ~

R Prcs:;1..-e Qrout Memod (ai. 011d.i'icd in 8',;i,r~Ji~)

No-rt=.: N~ t ce11J~t l$1M on!)' ::11116119 rnl!ll!ltnl .ippnM>:t for pr=..l!'o g1C>u\i11g,

"fl Onfl 0-.11 ·v ~ J to c lo l oc~h or C:, 5' •~1. 1•,i1h a mlrlimum h1J1n ol ~ lfich~~-

!J Clt;;,11 (11..'I ~cg ~ng ID O Iola dcplh of fact l)/IO t,i,c.lt; f(I \•/Ith tlf.ll)Sl)>OO $!:alirig IJIJl~fii,I (11 lor,i1 depth ls

1.lllkMWI), #nr.eci r~ ®ll!ITJ'li~ 10!:il d!IJIUI ciuiing deel1 cKJl °' '~ U). Nore: Im_! QlfflllJII 1$ 11'.e Olllt i;;u1i119 11\!lli<tinl ~vod '°' bi>cl:

M!nQ gmv~ vni:lccd \ve!l~.

(J Wc:iJ wis • rnm:I be penc.'<alcd Iii II,,; fl)!hnl1i119 tler,,lh:. pl!rir \11 lvld;lillino:

o ·Other: .;--------------------- ------------

. : .

Sanlo Clara VoUey Waler Diskic\ 6 5750 Almaden Expres.swa)'

San Jose, CA 95118-3586 (408) 265-2600

WELL DESTRUCTION APPUCATION FC 198 (10-18-10)

p39e 1 ol 4

► Please complete all information. DISTRICT PERMIT NO.: / L/ j?z_,(J 30 L

Well Owner. Property Owner: Name of Business/Resld:mce ill Sile:

The Hnmax Group, Jnc. Peninsula Corridor Joinl rowers Board caltrnin railmad tra~ks

Well o .. mer's Malling Address: Property Owner's Mailin9 Address: Addrus!; ofWell Sito: /I.A,..._,,. S.:t

1835 Barkley Blvd., Suite 101 250 S1111 Carl<>s A,·c I~ rt-10 ti ; ti ,!I_

Clly, Stale, Zip Chy, Stale, Zip City, Stale, Zip

Bellingham, WA 98226 San Carlos. CA 94070 Mouataio View, CA 9~0-U

Telephone No.: Telephone No.: Assessor's Parcel No. of Well Site:

360. 733.9029 >.:27~6 Book ill Paoe ~ Parcel ll.U

Consullant Drilling Company:

CB&l \\'1)och,:ud Orillins Company, Jnc . --· Address: Address:

400S Pon Chieaco Highwny 550 R ivC< R rod

Cit)', State, Zip City, Stale, Zip .

Concmd, CA 9452(1 Rio Vista, CA 94571 - ,. I C-57 License No.: Telephone No.: Telephone No.:

925.2&&.2274 707.374.4300 710079

-0 Check if addre$S or phone number has changed I D Chad< if address or phone number has changed

► All questions below are to be completed before permit can be issued; if unknown, ~pplicanl shall make on-site in11estigation to

determine conecl answers.

=="'·~---~;~ Original Well Consh'\lctio11 Permit No::

Well Reglstrallon No.:

0<0$0J.L.C,2 r FO_;,, .. ,.~·:....~ ---1-- - ----- -- 'fl;J 0,.,-7 f.J;/1 we11 Cas.ing Depth:

36'

Well Casing Diameter.

1·

This Section to Be Completed for AU Monitoring Wells or Extraction/Recovery Wcllr.

case l~ame/No.: Caseworker Narne:

!Jc. Lynn Suer ------- ---- - -Oversight Agency;

F.PA

D Well on DlslJic\ property/easemonl (See General Condition E.)

Well Oesi;riplion:


415.792.31'18

[gJ Vertical Well O Dew.itering Well O Elevator Shalt O Multiple Casing O Horizontal Wall O P~ Well

Well Type (ched: ah that apply):

D Water Producing D ContaminaUon Cleanup D Agricultural D Domestic

(supply or extraction)


D Vapor Extraction D Monitoring O lncflnometer [81 Groundwater D Vadose

gj Pil!l:omete, D lnlerhl::e D Suction Lysimeter O Seismic O lnjeditm/lnfiltralion

D Contamination Cleanup D Reclaimed Water D AJr Sparging D Cathodic Proteclioo

-•~#~-~g- ~c§if.½$m~m;;w§'ff~w.l~~r~-¥-'Q~~i~ ~~~~ Do~s the well have: 1. Ouler conduclor casing? 0 Yes ® No

2- Annular cement seal outside of casing 111 s.urtace?

3. A S.C.V.W.O. water metei attached?

[El Yes

0 Yi,s

0 No

® No

Type or Original Drllllng Metholf'

0 Rotary

iMPORTANT: A minimum 24-hour nollcc must bl.' given to Santa 'clara Valley 1/Vatcir District prior to lnstn!ifng the annular s~al.

Call (408) 265-2607, ext. 2660. Please allow 10 working days .to·proccss permit a1," I!:~~!;,;-; , · . . . . • ' L p-., .

. :,. •j ... , ' ... •_ .t. ·, •_I ,~ ',~

SaC.V.W.D. ____ JAfELLS

Sorfo GoJO Vo[e~ Wok~, Dr:mc!0

571K'I A~r,;v/r.11 f,r,,c,,.sw11r S;tr, .br.~. CA !!!J~ 16 l&fiS (-~<ICi 265 ;600

WELL DESTRUCTION APPLICATION r-c 193!1C1-1il-10)

Pa3c, :<<if4

· Plaasc o,.,:;aft;c'ln delta~ ~post:>1 <!JJ~~M m-:iuK?J (t\r1y v~~ Cfi\f.1ro-:·~ >'/l;lch lliir w,:M co:,ing I~ le 1i i;," pr;.i;a w HJ In \',N=h lh~ well

ha, a f11t,,, peck~it!Q tho. C'3S.ir,s, 111us1 ~ de:<1,-oye.d l.t!.il',.11Jp111a,ed r\eal c:eme111.11rat.):

t,.!e.a !2L"\~ IJ:)ltt ~ bt r~;>c~ \ti~ tho wi1.'l ~,,~~ hllil ,'to' I \~d~u .. fl\ fa . .c-rc.:;:. t¢\l",pn4!l=»'f&4 _;,.J:~ '1~ ~(:ntn1 ~ ,eLk.t ~ m~_tU!tJ <Of _;a rnir.U'.ei. ti.it

1~;;J.J.~S ft<lWi I>< l:ill•~"ilhe<oaml!c../.ll ~llpl):a;j ~ ~,ln)tq \<'JU t.. Cs>fb!l>I "'10 C.:~lUl~<loJ'r<•,"'•IJ',

!

. '-"'

.·,. 1,Jip:-ovoc! (hE' followin2 ~~•di<m ll"~lt-.Ms for lho w,,Jf C~<crlbe:1 L; lh!s r:=~

rr~::~ure Gimn ML>111oci (as ouOi«'K>d "'I ~aoo;yr~) ,.~ore H; ,lil tcn><:nt is the 01'\IY IIU6lli\g mulnri_Dl 3ppl'Dvcd t,;r J'fDS&Ufl> groulir.g.

p,m o:rt 1• . \ Jc, a tv!'lll rluplh pl ~ 5 !eel, Wi1h ;. m.nimum bor~ m -----~----- inch~\$.

D Clean oul \Veil casl~) IO a lot:i! dal)lh DI --~------ led Bfld bac;t. bll with apPtr111!;<l ... ll1'.al1rig rMlc.-iial (ll \01111 rfoJl1h 1$

-on~J1own. frin:i must delerm;n~ loll!l.d.:?pth eurir,g clean nu! of well). NOTE: Ne.i1 C1,?.mee111 Ii; 1hu utlly S(:alfn11 m;i.te:ii31 l!pp1011ed lcir t,2clt

folfln.i oruvT j:~cl:erl wells, l

n v.reil <l&!'lillQ mu;;t be ~orated ,,11he ~ic,wifto lli?p!h.~ pri0< lo L;icliildf,p:

0 0\h!ll: / ___ _________ _ ___ _

7 <

i ~- --· ·- ·····•·------··· ... .. ,- ----~-- -

}

San~a Clora Valley W~er Di,Mclo

5750 Alm!'>den El(pressway San Jose. CA 9511~3686 (4D8) 265-2600


Page 1 ol 4

► Please complete all information. DISTRICT PERMIT/;, //OCJ 3 ~1 Well Owner: I Property owner: Name ol BYsine~IResidence at Sile:

Toe Hom;,...: GJoup. lnc. Proi11sul• Com dot Joint l'o"m Board Calll3in railroad trecks

Vi/elf Owner's Mailing Address: I Property Owner's Mailing Address: .6.ddreu or Woll Site: A,./}.6--Y / ';/.

J 83~ Bivkler Bh•d .. Suite JOI 250 Sao Carlos Ave io1 61&110$1 / 7-/ o ' ..__ City, Stale, bp I City, State, Zip Cily, Slate, Zl;l Bellioghaio, WA 98216 ' Sao Carlos, CA 94070

Molllllnin \lic::w, CA 940B . ~

Telephone No.: Assessor's Parcel No. of Well Site:

360.733,9029 x2756 Telephon"" Mo.:

Boo'k ill. Page M Parc..1 fil

Consuttant OriOing Company:

CB&:I Woodward Orilli.ng Company, lne . _ .. .. ... Address: Addrel>S: 4005 rort Cilicago Highway 550 River Road

Cit)•, Stale, Zip Ctty, State, Zip

Conco1d. CA 94520 Rio Vislb, CA 9457l

TelephOnf; No.: Telephone No.: I ~57 License No.:

925.286.1174 707.374.43~ 710:)79

D Check jf address or phooe number has ,;hanged D Chedl II addrei;s or phone numb~r has changed

., All questions below are lo be completed before permit can be issued; If unknown, applicant shall make on-site investigation to


Well Regis\ralion No.:

OfoSO:l-W)-/ t:=jj 3 ~- ----~ Well Casing Dapth: 21'

Total Boring Depth: l!'

This Si,t=tlon lo Be Completed for .t.11 Monitoring Wells or E.xll'ac:tion/Recovery Well:,

Original Well Consuudlon Penni\ No.:

CJ 1.,000 7&. tr, Well Casing Diameter:

2"

Caso Nam!!/No.: Caseworker Name: ____________________ ______ _ _ Di-.:!-:-r.'!'_s_uec _ _____ _ _____ _ Overs\gh\ Agency:

EPA Caseworker Telephone No.: 415.792.3]4£

0 Well on District proparty/easernenl (See General Cnndition E.)

Well Description:

® Vertk:aJ Well D Dewatering Well

Well Type lc:heci; all that apply):

0 Elevator Shaft

D

□

Wale;, Producing (supply or extrac6on}

Vapor Extraction

(&I Piezomeler

D Conl.3minalior, Cleanup

0 Monlorlng

D lole:face

D Mul~ple Casing D Horizon!~! Wall 0 PitWel!

D Agricultural

0 lnctinometer

D Suction Lyslmeter

D Domestic

~ Groundwater

D Seismic

0 Conlemination Clcunup D Reclaimed Waler D Air Spe19ing D Calhodic ProteC1ion

D Municipal & lnduslr\al

D Vallose

D Injection/Infiltration

s_· 7

-2Am\~i-fil®8~~~~1.~~ Does the well heve: - 1. Outer conduclor casing? 0 Yes ~ No

2. Annular cement seal outside of casing al surlace? ~ Yes O No

3. A S.C.V.W.D, welermelerallached? 0 Yes 18! No

T1•pe of Original Orllilng Melht>d:

:IMPORTANT:

Cable-Tool

A minimum 24-hour notice- must be given 10 Snnia Clara Valley Wlllor Di~lrict prior to lnstDliin9 the annular seal. Call (408) 265-2607, 1:xt. 2660. PIGiiSC' allow 10 working days to process pernm ar~lll.rihDII.

APR 2 S 2014

S.C.V.W.D. WELLS

57:,,J A.i:'t:rko Exp~::.,~ .. w;:,.r £..m ~~. CA ~t a;.~i;,:; ,~vs, ~iIT~26c1 .. ,

WELL DESTRUCTION /\PPLICATION FC 1SSilt)-.le,.1~)

PiJO~ S~f.t.

t"loa~c d ¢bt:1jb!. 111 dc!:,11, '.hu P,.t>IX'!:04 1!~•$11\.'C~O.'l <l'll)\l1a~ •(Any w~l, l':11:At'lll.m Ir, Ml•~h 111b v.-.ill c-3cl0$ I~ 1ilf: i~ ~l::>c<> and i!, which lt,c, ._.,,'jj

I~ il ,lillel pac•: •o:Jttido :JI~ casl,19, 11111,1 lni ~ruy.-d l!cin~ .:i11p1c,v~ M;ll r,nn\0111 llfll\~):

1:6! c.tDiet,1 £10" ... "l ~•1 b=.f,:1mj'"1,! iPSU, tltr ~dl m!l tt::t:lq (t'c,m .. \-a ht-tlct'U ir'fi,~ r"a! ~ la.\\'.1'(3"'..dld 1::rl':..:: . .,\Jle:; ~ l"'1~:.r,lf \.:it;~· ~ :l, l '..!i \U:Jlt;m of 30 rn~. lh~

tlll.l£.l~Jb;:: J (;,,.r. '"'~ j-i-; rln,,J "-.\1 ...... .... ,,U'I.!. /JJ 11\,r'W"'ff(•,:.m .,\\d-•d ~:ill I C,~ 11'tlf1-/" :-r-4'! ,li\\\lnl't1 rx~, .. "'~~,l_J'

l;lole: / , . I

-t./l'l,-'1/3 -- · - ·-•~---,,'-·-----.l

1).,1~;

i' (o;/1

..-_[t1j Da\B:

f hc: ;istrt:l oi4 appr(Jlled tie follo~'-"J':1 i:l.,,;inlc:h,n meihod:. for ti 11, wer. uasc,1ibE,d I~ 1his pe."!Trii:

~ Prns:.ure G.~ovt hlafhod (i!~ e,J:i1n.."!.I II\ StswJ;:rc~) NOTE: N~)'I cornem i!; the o;111' sei.~r.J mr;terlttl 11.:-,prnvc::I fer prc:,surc, 11ro:ii."9.

~ Drit out "~ to a totnl depUI e>! __ . , ~ / (!oel, with ~ minirrr,m oore o! ----~----- !nci,ecs.

f::J CJe,_nt'<JI ,;,.,uGll~lng lbs lull1l d11pll1of -~--- fo<1I ,, ,r,;1 I.Qd< ruwal\ 'ilpj>l<>Y-"d«.'diiny nlat<>ri;il (rl'latGI d<.'jll~ ii

unlm:wm, )riUer 111ust &:tennlnn lolol depth dt:If11g dean ~1 cf'woll), NOTE: Neut a:me;\I b \lw only =fing m,iterfal B!lilrove.:I for bi0(

lini~ prav41 pac\i.M 11'l!lls.

:J Wtll ca,;lt,p must b<, pi,rfowl:,.:l 11t the lolkr:rhlJl d,,plhs prior lo l:>11(:!;i\ilin;r I

D Other. I

i -,---3/ I~ 0 f tt I c~~

l'l~fl- lr-4°<:'J 2_/ / s- i 1-

i, ,· I

5750 Almaden Bcpressway San Jose, CA 95118,.3686 (408) 265-2600

WELL DESTRUCTION APPLICATION FC 198(\0-IB--I0)

Page 1 of 4

► Please complete all infonnation. 01srR1cT PERMIT No/ ~ {loc, 3 <t>D Well Owner.

The Homex 01D\lp, Int.

Well Owne~s l·..lalHng Address: 1835 Barkky Blvd .• Suitt; 101

Cit)', Stale. Zip

~~nt. WA'.IS216

Telephone No.:

360.733.90::?9 x2756

Consultant: CB&I

Address : ~1105 Poll Chitn_go Hithw")

City, Slate, Zip

Cooc.ord, CA 94 520

Telephone No.: 92S.2~&.2'.l74

D Ched: If address or phone n-;:;mber nas changed

Name of Business/Residence at Site: I Property Own or: 1 Pt:11i115Ula Corrid01 Joinl Powers l3o>rd Callraio railroad tracts

I: Prop~rty 0..mer's Mailing Address·

250 San Carlos Ave

City, Stale, Zip

Addruss or Well Sile: /0 lil ew1i~ /1..li.t.A'· / ~ Crty, Stale, Zip

' SBn Cazlos, CA 94070

, Telephone No.:

' Mounuin View, CA 94043

A~esSDr'& Parcel No. of Well SIie:

Book ill Page !l:l I DrlUing Company:

Woodward l>:llli11g Company, lnz

Address: 550 lli\'Cf RoM

Cit)', Slate, Zip Rio Vista, CA 94571

I Telephone No.: C-57 License No.: 707 374. ◄ 300 7l 0079

I D Check tt add1ess or phone number has changed

Parcel Pll

1-- All questions below are to be completed before permit can be issued; If unknown, applicant shall make on-site investigation to determine correct answers.

Well Regislrallon No.: Original 'we·u Construction Permit No.:

1KWOO 71p · Qtc,~o~w:i...tr-o 3 Well C;,~ing Deph 56'

Tola! Boring Depth: • 59'

Wall Cating Oii,rne!er.

2'

This Section to Be Completed for All Monitoring Wells or Extrac_~onlR_e_co-,v,...o_ry_W_ e_lls _ ______________________ _ Case Name/No.:

Ove~ighl Agency: EP/,

D Well on District property/easement (See General Condition E,)

Well Description:

Caseworker Name: Dr. Lynn Suer


415.792.3148

[gJ Verti=al Well D Dewa!ering Well D Eleva1or Shaft D Multiple Casing O Horizo:ilal wan D P~ Well

Well Type (c::hecl; all that apply);

D Water Producing D Conlamlnalio11 Cleanup O Agricultural D Dome.stic (supply or erlracUon}

D Vapor Ex1raclion O Monitoring D lncnnomelef ~ Groundwater

~ Piezomeler O lnlerfac,, D Sudioll lysimeler D Seismic 0 Contamination Cleanup O Reclaimed Water D Air Sparging D Calhodb Protedion

D Municipal & lnouslrial

D Vaoose

0 ln)ectiorillnfikralion

~~~~i~if'3sxt:'ra'.,~~ ~~~--!t~un ... ...,_~~~lfl:~~-Does lhe well have: 1. Outer conductor casing? ffil Yes D No

2. Annular cement seal outside of casing al surfaoe?

3. A S.C.V.W.D. waler meter attach~d'?

T)•pe of Original Drilling Method:

@ Yes

□ Yes

D No

ffil No

0 Rotary '0 Cable-Tool O Hand-Dug Pil Well [ii) Hollow S!emAuger 0 Other.

JMPORTANT: A minimum 24-llour notice must br: glvon to Santa Cl;ir.i Valley Walor District prior to installing lhCl annulnrscal. Call (408) 265-2607, ext. 2660. ?least! allow 10 working days to procoss nermit annlir.r>tlM .

s.c.v.w.o . .___,_WELLS

51.

oR..

Sorfo O:im Voli&l:I Wo~r O:.-...l,i46

5-1 ~;• A!ma"dcu l:.):J)(!.·:--'S\..::i)'

SanJ::t?;~. CA 951U}:·m55 ((OS) 2.GS-7.o'Jl

WELL DESTRUCTION APPLICATION i'C 1~3 (1C-1&-1CI)

f'~_;)o l ::14

~ loc,=<> ,/e,•,:,it,c- In doMI. lb ,wii,o:u.-d <l.c.-:tnielion roelltod (f\11)' w.ill 1le~\,u~U:m it> v:hlcli d·,a well ca~1n9 :S. ,.,fl v1 pl;ice nnd in wh:cti !he well l

:1u): t. ~;ii:, i d( • lil~lllc ihoic:ni,19 1m1c1 ~Ill d~\~(ltt:d uti(9 ~pp:wed 11!!'111 ~uni .. r 1.;r1:,1rt): 1

n, . t UJ;l';Q'll~td "'" llo rM~1,1.:ol in)1n1l~ ~,;:11 c::di;:: ~ Jl,r.v ,,-.u t-:>t.Ltcn l!> "'"" fu: 1~,~~·r.•c,,J,4 !Ul/'.i«·. 1,1'.i,: tb: «mr.>'.l..i StJ ft,.~ ir.io:mu,o d)C,.ina:C!, ti>•

lc--:t.1-s ,mo.: •:vt ,\~1JM <,>)t.tt,vii~ cc •:t.-' ,\R d~tt\r-'-r.i :;v.:eJy.•,'.f:) adU \.t: UfU,A"t4i .o,I cn)J..;.--ct:! • !fJfr,p:,~l\

l~'.:ki..~~~--1£1~~~-&~\t~ JJ,?.1:11:fi:lffi~JfRF~~.s~~~-;-. · ~ .:a.-;,•~~~..,_~ ~~~-- · .. 1~...0f&$J~~~~t-;~":!$J~)~~~-"~j~~~-l;~ ~~~~~~~.

i und{,r;tand 1111 (!glt/C lh~l -a& v,uri; ll5~~~1elf l~l'JI this f)Dll ~i1 Is 10l!~irod10 be ilOfl1! in o~d,mt:'} \I.it\, Sapia Cbra Val!ey VI/a t~• DjS11i:t ' -,

(Dlsui,;~) Well O{{!Jnar,ce 90, l, 1l1i, ifa1rk;t Well Slon1lu1tl$, Mrl co_~dl1io~ of thi.; peur,lt (G.."<':- PO.!le <). I ccr1i1't lhol 11)0 in~tn3:io1' ;f\•(:n ln lie

p,,,:rv. i~ OOITl!cipo the be~I ofrny 1«1:,wlc'J~. n.-.:1 \llal L'>e~ ifl_t\oll~'lt: belt.,._., wl~l!it7 o,i!Jbi,,I_ (:ltdrcolc. or !'1ol(;G(l?le.l • .r. .iuOl(lrircd llnil

,,.,,,.J, SIi:! is :if1i c-d wilh tho int~,11 tl, tre (lf'\1<>11::c~lllt:. I i1,o cenir)• lha l a 11g111 ot ot11Jy/e..::n:;i.:l11Ticoll astw n,t:fll h.->~ b~,in frJm1,1f~<:•l IY.l1w1:,il11

1h,; weJJ O-,',f\61 and· prcflcrly '0',\1\01, if pat1i~s .liifftir, ,

' >•*••••w••~ -· . !:: CL,yp/.5VIV l ?,•e•~.>~.'/~2 . !:::tmtu.t! •>I /!"u,-.,,il'll)' 0y.'7-r.,.t;f\!pt.r,\:

t,.,4 {v'-'\ ~ (-\ · a VI v?.~rO .:_:t.J!.~ / I Si!ln:ai,;r.; Mqillqj"I;:~- J"rt:11 li:111~ !)~i,,; 1

~ :)rill 011\ w•·f lo;, lol~I de¢, oi .....:.--~---- r~et, withe minL'llum b.:>re (/. ____ 8 _____ Inch~

O C.lc;:on out -1,~n cagr.9 ton toi~I d;:~lh c,I _ _ _______ IP.el ;in,! b.id; fll vr.!h ap111ov,:d Matin~ ,naterial (ii lr,li,I d<>pf.li;,.

un~.n:,.vn, ~oiller mu~I dr,lcrn1ine tnt'l' d,,pth duriu9 de-'O out of W611). 11.'0TI:; NC!al ccmertis !he on!y (;r.;i~t13 mate.;111 appto\Md for Ii..">(;)(

!ifli:,p ~rnv~l nac:!<ed wells, . W \ll'(~i ,\."lS\fli mus,I be ~ti(>falL-0 lil lh~ follc•Nirli) nc.--plh!. prior IQ b;,ci:liffJt1g: ----·~-----------0 :)Jt$: 1 ..... ------------~-------------------------

Santo Claro Volley Wale, Disl,k!o

5750 Almaden 8<pressway San Jr,s!!, CA 95118-3685 (40~) 265-2600


Page 1 of 4

► Please comptele all information . DISTRICT PERMIT NO,; i.(

17 C) L) 351

Well owner. Property Owner. Name or Business!Residance al SIie:

The Ho:n:o: Gfo»p, Inc. l',:ninsula Corridor Joirn Powc,s Bo3.Id Caltraio tailrol!d tr..cks

Well Owner's Malling Addtes.s: Property Owner's Mailing Address: Address of Well Site: ~ .. 1835 BwidC)' 81\'d., Suite IOI 250 San Carlos Ave J~t 11-10 (/, //.tL SI-City, State, Zip City, Stale, Zip Cffy, Stale, Zip

~~in~ WA9&226 S1<11 Carlos, CA 94070 Mouotain View, CA 94043

Telephone No.: Telephone No.: Assessor's Parcel No. of Well SIie:

360.733.9029 >:2756 Book .ill Pag!l' M Parcel ID

Consultant Drilling Company:

CB&J Woodward Drilling ComJlilll)', lno

Address: Address: .

400) J'on Chicago H1ghw•} ,so Rwca- Ro~d

City, Stale. Zip City, Stale, Zip

_C_o_n_co_r_d._C.A_' _ 9_45_2_u _ ________ ______ _ ____ ;.-• _R_iD_Vm __ :..;.,CA_9_4_5_7_1 _______________ _____ _

Telephone No.: Telephor.e No.:

92.52SS-2274 107.3?4.HOO

' c .57 Licanse No.: , 7W079

0 Check ti address or phone number .hes chariged D Check if address or phone number has changed

► Atl questions ba,Jow are to be completod before permit can be issued; if unknown, applicant shall make on.site investigation lo


--~J!f$S~ Wl'!II Rl'!gislra\lon No.: Owner/Consultant Well.ND.: 1 I

~ 5° ;)_ll)0,./ t-0 J.- T'-IA •• 1./ 5 01i9ln~I Wetl Construction Permit No.:

rwocn s-Well Casing Depth:

J(,'

Total Soring Depth:

j 36'


z·

_22!!~ Sec~on to Be Completed for All Mcmi~?_~':'.~ We!ls _o_r_E_~ __ cti_·_o.-._1_R_ec_o_v1_e_ry_ W_e_ll_s ____________________ _ __ _

Case Name/Ne.:

Dversi3ht Agency:

EPA D Well on Dislricl property/easement (See General Condition E.)

Well Description:

Casewor~er Name: Dr. Lynn Sucr

Ca&eworiler Telephone No,:

415.792.314&

!Bl Vertical Well D Dewaterlng Wall D Elevator Shan O Multiple Casin9 0 Horlwnlal Wall O Pit Well


D Waler Producing D Conlaminalion Cleanup O Agricultural D Domestic

(suppty or extraciiDn)

0 Vapor Extrac:tion D Monitoring O lncllnometer (gJ G1ounowaler

§ Piezometer D lnlerf;,re O Sudion Lysimeter O Seismic

D Municip31 & Industrial

0 Vadose

D lnjedbr,/lnfiltralior,

0 Contamination Cleanup D Reclaimed Wa!er O Ait Spargl119 D Calhodi:: Proteclion

-~~~~~~=. =.== ...... "":"'~~-=-=, = :-=~=;. ~=···..-= .. =r-r=1i1.tf=;ts..m.i = .=,~=~; ,=i-~~"""'-~ ~=~=~~=-=:,

. ---~ ~ ~ --r-wl:-~~~\;.~~ Does the well have: 1, Outer cond~::lorcasing? 0 Ytts © No

2. Annular cemenl seal outside of ~sing at surface?

3. A S.C.VW.D. water rneler attached?

Type of Origin:,I Drilling MeU1od: . . . .. . . ' . ' . @ Yt<S

0 Y1.,s·

0 No

~ No

'IMPORTANT;· A minimum 24,hour notice must be given to Sanla Clara Valle>· IJ': ,. . 'li, · . !:' , ,· ic ~., n .t ;, I •!J t · . .:. ,, ,u 'al' sn;il.

. Call (408) 265-2607, exl. 2660. Please allow 10 working days to p· cEi -: 1 n t ai .... ~ · ti, ,

APR 2 3 20l4

s.c.v.w.o . .,_ __ WELLS

;, ;,

! ,.

op._

I

Sonla Oa10 V!Jl]aii:1 Waler Piiri<i()

~50 /\Ihm~ 11 e,1"£S!- •.,y , l:lh .SW.:, I:>, ;<' 1 IC· :.ic:&ll (•103) ?65-Zoi)(I

WELL DESTRUCTlON APPLICATION FC 1E8 (10-11'-11:'J

l"ap .. J« (

r1r;;;;;-~,an:o11 \;;i'1iu,11, lhc pro;,,msd CC.S\f\Jtl.;.· 111~d'°? ((lll)',\VCII do:;W.:t",on In 1Vhle.11111: wr:H r,asj(\g It loft tr, !)lace and lt11·ma:h lb: well I )ins R lilil!f P2~ OUIGl!le lhc., cz~lnp. rnuS'. b~ des!loylm usi:1.c1 e;ii,ro:n:-d ne,11 ,:e'l)CJ11 glcrul}: i

.... ·-~ ""'-· ,, ,,.,, •• ,. ""' -"~" •=•• ,_. "'"" ,,., ..... ,.,_ - ~-. . ~ w "''"""'= "" -•. ""j •~•-> "•~• <••N• -••"'"'""'•=•=••U .,_. .... _a.,-,,.,,,

~., -l;•:.~~Il'~#1?Mfui"l'!:~~•~~~~~~~~~

f!'~~~3.{r~~~~~~~~.)-!J~~~~~-~-,§i

t 1incl~~hmo dnd ;,groolha! i,ll 1'JOl1< =~!alt:d ,1:fth 1hlr pc,rne~ f!!qul/id lot:~ dr.irie iii llC::Old1U1W wilh"Sool3 Cbr~ V.ilTt:yWuler Obllii::l I (Di~r:ct) WrJ:~c'lnlllr~ 00-1. 11\c.(~ls!fJsJ WeU Slar,dardcco"d con.'.1~.ion-~ orrta'i ~ •nil (seo r•D!)ll -1). I ~u,. th:it l~t lnformmon g.l.cm If, Irr½ I p<,rm~ •~ eo<,\).:119 11\o bvel cf my b10'.-l"'d!¥1c 11r.:l lhaf fr~ tl_jl~~lllrll i>Dlow, 1.+. .. 1lioro,iir11::.l,.11h1·cl•0~, er pl\oloeop!od, lc.:nlih~ri:">:I on:!

l'aiiu. and is aff,x~ wtlh lho lnlM( IO~ c,~fcv,0,--11:il~. I ~l!;() cerf,"fl'th&l II t~I of enls1•/.,11t1c.,11cl11nan\ .i(lle.:t/1(1.ll{ lr.r!i bMn S.,:milned bclw~n

:hE! ,....ia c,o.v11~ and p,o;Y..itty Cll\lrllll, Ii partl~s \imClr. ---- -~---- ! ~Ch~Z2p~n. ! ~2~omo: r. - -- 0 ~i 117, ~ - . -

1

~-:- -~·· ... --- ~.l-S_ c..&M-?:i'V' ·-----+~~'/_1.__ _ _ _,

!-.'tJ;i..-.~1~~ ot Pri?p,tJ.:1)· (>Qu~..,,;,~,.-.1t. F1in1 tt...,1lol.! Om1::

~ OA•p/ Ar a JI {,{+:J 'f ({C?/ I .,

---- ·- ~ - ---f-c---'-;,...____.___...,

f"');,a;,.,,t, <>f O,l:iarf;,i,:.,!':? Frill 1-/a,r.e: Dal~

'(. , .. ~) I I

~ r- "/1 " It/! .•-.n

'fbi,-Ul!,lli::t .,, i\pJ~v-cd rhl! loJowinp d!l!ltru:tlon tte~ for U"- \~1.ii d erlbflll tn lhls, rcrml'.: ? A P;i: ~-r,u re'!Jmr/1 1,1.411\lld (.1$vu'Jln:.!111' S!Mcarrlc)

1UlTc.: N~,11 t.::rrn,r,i l.lli·o:il)' 'S~a/lng metilfial npprorcd lcr !=Me gro,111113. ·, . . -

~ l)11 .1,1J1\'l6110 11ltnulil pthol y I 1;, l~ilt,w!H1n111i1Jlmu:i1b:rool

~

'6 - lod=&.

O Ol1<:11'I 1111)-Wtl! t:.1sfr~r lo 1rto!.o.i d~\h of ~---- --- IC!CI ilfn! lwd. 111 wllh OOJ)l'av.id ~ilafllltl tMloriltl {if total dop\h It

1111):r.o\""IJ d'r~l!,I 11111~\ del!irrr,iM 1r:::1nl 6ep:l-. dun.'IQ d~I\ :-..ill ol\•1ellJ. O"l'I.:: Nenl i.:cmcut b Ill<? o"1~ ~ h'Qlenal11ppu,vc:d flll"~

(,11,ng 0:,1~(!1 pr.x~ vlclls. , · 0 V.-c( i;:3.,-io9 fTIIIS1 bejld1(cmtd ol IM fQ!l:t,.irig d!l;>:t\S ~1i,i iobnt:1:6lr111g;

I

-'~~

Sanlo Oaro Valfay Wdet D;ruiq 6 5750 Alm a den Expre$$V12y

San Jose, CA 9511 ~3656 (408) 265-2600

WELL DESTRUCTION APPLICATION FC 196 (10-18-10}

Page 1 of 4

>- Please complete all information. DISTRICT l'Ei~PdO 3 Sf

Well Owner: Property Owner: Name of Business/Residence at Site:

The Hom ax (J1oup, Inc ' PcnimulD Corridor Joint Powen; Dwd Cnllrllin railroad lro<:f:! -- --· .. , . -·- ••••h•- -

WeD Ownefs Malling Addiess: l Property Owmer'$ Mailjng Address: Address of Woll Si\e: /7-10

If.JS Ilz.r)j:)' Bh·d., Suit<- IOI 250 Si111 Carlo~ A,•e ~/1/p_,, .. / 57

CitJI, Stale, Zip Cit}', State, Zi;> City, Sla_te. lip V/r/.-~-

lkllinglrnm, WA_~~~ I Sau Clltlos, Cl-. 9~070 Mountain View, CA 9-t043 ···--·--

Telephone No.: Ass.essots Par~I No of Well Sile:

3~.733.90)9 x.2756

I Telephone No.· Book ill Page .!!:I. Perce, ill

Consullant Drining Company:

CB&l Woodwa:rd DrillinE C<."'11/M•)', lnc --Address: Address:

4005 Pon Qiicago Highway 5.SO River Rrod

City, Stale, Zip Ci!)', State, Zip

Ccmcord, CA 9/4510 Rio Vist-. CA 94571

Telephone No,: Telephone No.: ! C-57 License No.:

92~.2&~22?4 707.mAJ00 : 7100?,9 ·-···---·

0 Check ii address or phone nvmbe1 lias changed ! 0 Check if address or phone number has changed

1--- All questions below are to be completed before pennit can be issued; Ir unknown, applicant shall mal<e on-site investigation to

d1:1termlne correct answers.

~~~~:il -~~-. . WeU Reglstr.ilion No.: Ori91naf Well Construction PermU No.:

- ---=O'-(o= ·=c,--"''e..:;W"'-· _2..,__1 .!...A -=-.O,~=:.;:- =,:-;_-_____ _ _ _ _______ qc.._1_iJ_..;;_OO"J-9._. -·----Well Casing Depth: Total Boring Depth: Well Casing Diameler.

~o· 41' 2•

This Section t.o Be Camplctcd for Aft Moniloring Wells or Extraclion/Roco\/ery·W&fls

Ca,-.e; t~ame/No.:

01•ersight Agoncy:

EPA

D Well on District property/easement (See General Cand~ion E.)

Wall Description;

Casewor\ler Neme:

Dr. [}"nh Suer


~15.7923148

~ Vertical Well O Dewate1in9 Wen O Eicvator Shaft O Multiple Casing O Horizontal Wall O Ptt Well

Well Typt, (check all lh>1I app!)•):

0 Waler Produdng O ContarninaUor. Cleanup D Agricultural D Domestic

(supply or extraciion)

D Vapor Extraction

[i?) Pie.zomi,lar

rJ CQntamination Cleanup

Does the well have:

0 Mcniloring

D Interface

D

1. Ouler c:ond\Jctor casing?

D lnc:linometer

2. Annular cemi,11I seal outside of eitsing ;,t surface?

3. A S.C.V.W.D. water meter atlaclled'r

l~•pe of Original Drilling Method:

0 Rolary Cable-Tool Hand-Dug P~ Wen Ho!low Stem AuQer

ll'cl Groundwaler

D Seismic

Yes

0 Yes

0 No

@ No


D Vadose

D lnjedion/lnfiliralion

/.I.PR 2 3 2014

s.c.v.w o WELLS .

57!:.0 Al;t,&j.~n Exptc~~\·lil)' San .~ ~, CA 951!t-3" 5 (4M) 25S--Zti1X'

WELL DESTRUCTION APPLICATlON r,:: 1!<$(10-1!1-l(;J

P;,;,te. ~ o! (

f'ltcl~~"I.:.. 1k:1czi~.',, in 1l~il, u,~ P,~jl,>:..;~ ,ls,t.l,~:,-\i,111T1t,ll1~~ (r\llY wGIJ OCStru."'Jcfo In w~Cll IIl!> W!:ll c.a.slng Ir ;en 1,1 pl~;;;;nd ,~ wh,:.'1 the 'hellj

lrns a n,:1,1 p.~cl: oi..1Haie 1h~ r~~smg, mu!<\ be at:~iroyed usm11 app,avi;.~ nc~l oe:,1!:nl groot): I ~I .t-:m=t-~ r.n,1..1 _wilJ t,:;~,,~,Cjm~ \l~ "A~I crfia::,,t.t...1 f"lt. (jom v--c'li IJ(iltp-ti ~ frTc f~et~il ~n~ ) '.11!~~ Af:o 1hr r.;::~l b¼t: t,;c; fer 4l rrJ!ll:n~r:l c,fJ(1r..b;:.l-:.l , ~~ j ::::1:t~ur.:q; 5 r:-.::c 't ill t,;: fil~ w,,htt<>'-foC.!L.. ·"" 4Ju~k.~ ~ ,Cl,I.:~ , ·,'11 l . '""~J-...,,.1 t!1!>~~ r:(Jt!0;>:-:1)'. I

JfJ. f.'li!l wt wtll tc, a IO!tol d;;plh ,.,; ___ l-/..,..,/,._ _ ____ iee!, v,t()J e rn!r,l=m r,o,a of _ ....;a'6::___ _____ k.che,.

Cl Cl~a11 ~JI v.·eTI c:?>ifli/ to ;s \Jllnl ci,;rpth ::-1 . ____ -··- fo.e: ;x;d barJ-; ftJI v,ta~ &pr,tmed sealing matcr,al (i! lollll dc;:,th is

us1Kn:-.vri, drir.,er fll!/~1 C!el9rmtne tot..t (18;.>lh ~Uil/1Jl :;l&M oul i;,fwalfJ. NOTE.: t-kat c!!ine.;t It the o:ily ~e.'llin~ =t~.fia• appm,-~d b: bod-.

fillm? 9 rn,rl s»cl;ed wells.

'.:I We!, =ho must br. f>"Jlorn!e.1 nl 11¥.> '.db'.vi!l!J di:pthr. ;.0:ior to bad.1illin:1. ·- ···- -·· ·· - --------

-------------------- - ------- - -------- - I

.

Santa Cbro Volley Woler DOl,k\6

5750 Almaden Expiessway San Jose, CA 9511&-3665 (408) 265-2600

WELL DESTRUCTION APPLICATION FC 196 (l0-1S-10)

Page I or 4

► Please complete all information.

Well owner: The Hom~ Group, lnc.

Well OwnerG Mailing AdClrest:

1635 Bmklt}' BJ"d,, Sui le IOI

City, Stal~. Zip

DISTRICT PERMIT ij0.:

I Property Own~r: Name ol BusinEc>s!'/Res\den::.e al Stte:

l'cninsu!a C'-'lrridor Joiilt rowers 13ollld Ctillrain filiirmd 1mks

, Property Owner's Maifinn Address; Address ol Well Siu:: V · /. <: .,1,-.,,. 1-i. 0 'I .(... '::..-, 250 S:Jll C:ulc>i Ave l~t /1..).L>.,- -r/ City, State, Zip Clly, Stal.I!, Zip

Bdlinghon1. WA 98226

Telepho~c No.:

~60. 7>3.90Z9 x.2756

J Sm c~rlos, <;A 9-1()70 Moun~ V~w. CA 94043 ------ti-T_e_le_p_h_o_ne'-'-<N•u·.-: ------------1 Assessor's Parcel No. of Well SIie:

1 Book ill Pag~ .IM Parcel P.U COl\sullant

C8&1

Address.

4005 l'crl Chi~•go Hil'h"•"'l'

City, State, Zip

CoJ1co.-d.. C,\ 94520

Tc.lepr.ont. ND.: 925.2SS.22i4

0 Chedc if address or phor,e number tias cilanged

Drilling Compan)•:

Woodward D.illing -~:":P_;ll,.;>c..'·_ln_c _______ _ _____ _ _ _

Address:

550 Rlvet Road

City. Stale, Zip Rio Visa, CA 9H 71

Telephone No.:

?07.3?4.4300 ' C-57 li.:ense No,;

710079

, 0 Check if add;es:; or phone number has chanped

~ All questions below are to be completed before permit can be issued; if unknown, applicant shall make on-silo investigatJon to determine correct answers.

Well Ri:gl.lr.illo No.: Original W~~ Construction Permit lfo.:

___ O"-~?0.~~v_'.J-,_· .,_l ,_--=b..:...~-7"----+--------~--1----...;.q...,_•--'-w"-o_ l_.>--'-tp_.2.__.._ _ _ __ _ Well Ca~ing Depth; :Total Boring Depth: ~J H'

This Section to Be Completed for All lAonltorlng Wells or Extr;iclion/Recovc,y Wells


2"

----- -------,.---------- - ------------ - - --Case Name/No.:

Oversi;lM Agenc-,-:

EPA 0 Well on District p1operty/easement fSae Gnneral Condilion E.)

Well Description:

CasewoJl(er Name;

Dr. Lynn Suer

Casewor1<erTelephone No :

.$15 .~92.314&

~ Venical Well D Dewatering Wei, 0 Elevator Shatt D Multiple Casing O Horizontal Wall O Pit Well

Well Typt (ched\ all that apply):

0 \/Valer Producing D Conlaminalion Cleanup (supply or extraclion)

0 Vapor E.xtradion

~ Piezometer

0 Con:arnlnation Cleanup

DoeSs the well have:

D Mon~oring

0 lnierlace

D

Outer condudor casing?

D Agricultural

Annular c;,m,.nl s1,al outside of casing al surface?

J. A S.C.\I.W.D. water melllr aNache::I?

Type of Original Drilling Meltlod:

0 Rotary ■ ,. , · .. ■ . .• t •

D Domestic

0 G,oundwaler

0 Yes

~ Yes

D Yes

0 Ne>

0 ND

0 Municipal&. lndllSlriPI

0 ViidoSse

0 lnjeclionqnfiltrallon

·1~PORTANT; A minimum 24-hour nolice must be given to Santa Clara V.il!~y Water'Dlstrict p~io; t •· :. , •~11· ;;-1, :: a-;~ .J'.~1 ·;; J' Call (408) 265-2607, ext. 2660. Please allow 10 working days to process permit apr,11: 1tlc . ·a ··

APR ~'. 3 2014

.·,··1 / · ~:I I '' • , . , ' .

San\o dorQ Wille\:! Wah • ., Dihiqo

~.T!l·:l A\:r.i:.k-r+ bP.·~wa--, Sar, J;:t. eA !,5\!S-.*li:: <~~S) 2 .. ~ ~:i():l

WELL DESTRUCTION APPLICATIOt~ fC 1:l'$ (1 11•1 10)

r-~~ 1 o!,.

Pie~~~ in iil:taU, ·,e J;n,p:,:-e:! dt::l/\i(IJor, IY',<J lM~.(AIT)' w,11i"~st11Jc!lllll WI l\s')lth :hi,_ wel, 12sin11 -i; l~U~~ ~;~lie.", lt-.c 1-,ell 7

r,;.s ~ m..,,- pic!( o ,.d,;ite t11ee.wn9. rrlt.1$1 ~ dutlfo>•~,I U.!11'1) 11pp."W110 neilt ~11m~~"' !J'Ol/1>:

)';~.u :q11 .. 1....,, mu Ii: p:,:,1,cd.i.::11' u,~,.,11 ••1i11>_; jt>.1~ !rv" "•t t>:•n: c 10 live,,._-: l~;,,..-Pl'""'d s-Jrr.u ,U'lc.: 111n,:,1.1~r. fr>.< ·•"'- ,,. .,-:;v.t=o ,,n~ r::-1,...:::,,, ~•,,

n=•..t.: S (<et 'f:ll he fill::l i<; t>, ::on:m ,\I! 01>1,.,,.-d !JlT,1<¢.•=t<,Ulb::~,d i:-il dq~-;-,~c,.'1•11.-;-aly. ! i .

O CY.her:

~--·-------------------------------------~

Sonla Goto Valley Wa'..er Disl:ricto

5750 Almaden ExpressYl'cl)' San Jose, CA 95116-3686 (408) 265-2600

WELL DESTRUCTION APPLICATION re ma (10-111-10)

Pa~e 1 ol '4

► Please complete all informalion. DISTRICT PERMIT NO.:/ 7 poo 3 .. 5-.s·-

Woll Owner. Property Owner: Name of Busin2ss/Residenc.e at Site:

Th• Homax Group, Inc. l'cninsula Corri ~or Jouit Powm B cwd Caltrun n<i\road tracl:s

Well Owner's Mallir,g Address: Property Owner's Mainn9 Address: Address of Wert Site: /Lf}'A..r Sr

ISJS 811!1:lc)• ):!h•d., Suite lOJ ;250 Sm Cnrlos Ave ~et,1109r /1-10 V, 11,,,_

Ci!}', Stale. Zip City, Slate. Zip Clly, Slate, Zip

Bellingham, WA 9!:126 .. Sall Carlo~. CA 94070 Mountain View, CA 94043

Telephone No.: Assesst,r's Parcel No. of Well Slle:

360.73.3.9-029 x21S6 I Telephone No.:

Book 18 Page lM Parcel Oil

Consultant· Drilling Company:

CB&! Woodward Drilling Company, [tle

·- ~.. -

Address: Mdress:

4005 ro:1 Chicago tlighwa)' 550 Ri,•er Read

Chy, Stale, Z-p City, Stele. Zip

Conc.ord, CA 94520 Rio ViSb, CA. 9~571

-Telephone No.: Telephone No.: I C-57 License No.:

925-2.t8.:?.27-1 707.37H300 710079

-0 Check if address or phone number has ehAng~d D Checi< if address or phone nurnbor J\a$ changed

► All questions below are to be completed before pennit can be issued; if unknown, applicant shall make on-site inve:.tigation to


Well Casing Depth:

~IS

Well Castng Diameter:

2·

This Section to Be Coroplcted for All Monitoring Wells or Extraction/Recovery Wells

Case Nam a/No.:

O\'ersight Agency:

EPA

D Well on District property/easement (See General Condition E.)

Well Description:

Casewo111er Name:

Dr. S ynn S11<:r

Casew(ll'ker Tclepoone No.:

415. 792.)148

fiil Verti::al Well O Dewatering Well □ Ele11a1or Shaft O Multiple Ca~lng O Horizontal Wall O Pit Well

Well Type (checlc all that apclly):

D Water Producing D Cont~minall □n Clealll.1p D Agricultural D Domestic

(suppfl• or extn,c:lioo)

0 Vapor Extraction O Monloring O lnclil'IOITleler @ Groundw.,tor

® Plezomater D Interlace D Suction Lysimelei D Seismic

0 Contamin:;ition Cleanup D Redalmed Waler O Nr Sparging O Calhodic Proteclion

0 Municipal & Industrial

0 Vadose

0 lnjec:lionllnMralion

.

--

·~tt!s~o~~,:-·w'~1~~~~=0=¥9'.=tf~"""'~""'-= = .= . . =~="'"'~=•r"°='a~ ·)ii!=. ill==~=~-

-~~-.w.J~,~~~~~~.~~~!'!'~~~ Does !he well have: 1. Outer i:;onduclor casin11? 0 Yes (gJ No ·

2. Annular C!!fl'lenl seal outside of casing et surface? [81 Yes D No

3. A S.C.V.W.D. watermeler artached7 0 Ye$ ® No

Type of Original Drilllng Method:

□ Rotary O Cable-Tool O Hand-Du11 P~Well 00 Hollow Sle.rn Auger

APR 2 3 2014

s.c.v.w.o. WELLS

oR..

Sonlo Clara Vo!ic~!;l Waler Disuict6

!i?50 Al1 11;,dP.n r:.,q,rcss.way s~n Jnsr.. CA !1~110-:IC-66 {.1:;0D) i?C!, ZC-00

WELL DESTRUCTION APPLICATION IC !Ga CI0,1 R-10)

P~gc 3 014

pj.:a;; d;~criLt;i~ detail~ ,h; P'<'f)OSUd lk~lrut;ticn ~lli;d {Any \\le)i.dusl,~ticl·~·,n which the wen casln9 is l&ft .in p;;~ ·.;~-i~~.;~.h the v,ell has. a fil(or pack oulsirln lh<> <.-J~;"'l• n:us! hP. de$lro~ed usiny npprove<.I nao1 cP.mr.nt grn1:1):

Ne.al "ITK\ll wotr.. 1,):1 \,r. pum~6 i•1ln 1h: ~y-jl c.a.<&ni i,t:ud",t (,rm• wcU 'ba!Jo;c " r.-,e. rc-c, \d1,.1\\' gmut>d_j,,Urlt:.t. All'1 the cn~"II h~ 5tl SO: " min~u,n of JD ,n;,~:¢... U;e rcm&mu,i > (ca wit/ I>: llllr.4 ,vl11t u,um1c. AU <lhpl~~ tJllWll.i,..i<i ,,.,11 !'< <-r<•«J ,...,1 ,H~•r,,tJ "'I"'"'""''·

W$~~f. i:~1,:~~~~~~~~~i~~,~~~1f·~~]~&~~~~~l~il~d{~~~~f 1 undo1i.!611 rl nnd 11oroo lh111 A.11 v.m~. a.s~ocialot1 ,~nti !hi, pcunll ~1C(111lrod lo bo dono In o~coraol)()tl 111!th Si:11111, Chuo Vall11y W~!ar 01:slnct I (Oii;Jhd) Well 01dinanctt 00-1. lit!: l)isfdcl Well Sla11doms. 11nd condlticms ol lllls pe1mil (see psgll>.-1), l ceuifr 1ha1 Ll\6 lnli:innrillon gi" n in this pormU Is corr(lct lo lhu bast 01 ,nv kll!Willlc!SU and lltat lhas,gna1111~ bl!IOW, 1•/hl!thcr 01lui11.il. i!J1M.11u1~c, Uf !)IIOloruplcd, ·~ uulhufl(od en!! vallo, o.OYJ Is slliterl vlit111t1c rnlanl lo ho cnlorroablc, I also ro1lify IMl :i righl ol en\ry/encroachmenl agreement has h(!tm lorma!i2ed belw&l!n I lht: we:11 own.,, and proper!)• 0WT1er, ii po11ic) rilff<l/,

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lhtt Distri:',t has apr,mw,tl lh<, infowina de~lruclion rnall'lods !Of lhe well !1escribed in lhis peunit:

~ P,e,.3(Jft; Cro,~ Mc:hl>d (ot. 0ull1ood in Sl2ndardc) NOll:: Noa\ cerieril iG the cy.,ty ot!al111g maleliol ap;:tovcd roe pres.sere grouting

)llJ Dnn 01.11 well too total deplfl uf _ _ , ___ '-j__3~--- feet. .....,;1h ~ mioirm,m bori: of _8:a., _______ _ lnr.oos.

0 Cloao oul well casir,9 10 :t lal;tl Ct'jllh cf ·--------- fer.I ~n.1 h::tr:l hll v.1lh npprnv~d S(!/lllnQ m11IMUI (II (olal depth·~

unkriown, drillor mu!.:! delermire 101a1 ucplh d1nin9 dei'l'l oi~ of Wl!II) . NO IE: Neal r.emenl is the onl1• scaling malellal approved tor bac:J(

ti'ling gravel packed wells.

r1 V/~n ca•ing mue.l t,., p.,,for<1lc~ nt lhc lollawin11 d aplhr. priot lo b~ckftlli"9: ···-----··--------D Olhgr.

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WELL DESTRUCTlON APPLiCATlON . F'C 199 (10-18-10}

► Ph••~1h:pmpleta an lilror_maHon.

v1eno,,11~~ P:(oP.Uty OWi\tr. s.ot, Cl,n Counf11141«." £Ail\Orl.< D<pulnu:i,l

N:1'1111 of8'11fllwlllriui:!co.~ or s.~ ~u&!t,t,Mofo-l~i Addru~ of Wen Sita!

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<1UC,:\I011• holo)Y :1ro lo ~ C9mPlolotl b!ll.ore 1>•tmll c:an ~ 1"ued: 1f ~nknOV/n, appllt,aJ1l 1,liall mal<co "";llllll lnveetignllM to da-t~weco~ctansw~. _

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~eclfon '° Be-Qqr,y,Mad r« .All l>)orillJ>1fa; W.~• 'l\f Edr~p!onlR..,..;,• tjVt.WI,<'. Ca~ Ht~~.: · · ' • C:Ocr.ilcr'Mr ~.:

D W,:IJ cm Pblrict ll"'J1ror1)'/111rn111gr,l'lSce, GenlJal C<,tldilll>n ~) Well bl,u.,ipllon!

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!Bl Veitlcsl!W~ □ Pffl'IIRt~ngWell O ~1lorSh11l Q ~~oe«sl;-o O H'!M1rJ>r,leJW•~ 0 l'il~'\!e~ Waif l)pe (cheol. 21 th.1 appl)I): El WalR,t J!f~u~ • 0 Colllanlll•liorl c!"n~p

(suppl)' or .mltadlan)

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0 VGPor Extlacllon ~- loloni!OdnG □ ln~tW !Bl GIOlll"llv,alcr b Vadosa b Pirmmeler □ tn1erra... a 0

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R~~~!~l~D ,JOl:1 COPY H-J~I be kept on Job site at all Limes. .i

s.c.v.w.o. Pen,1lt No. .1~ -/ JtJ ~ ~ WELLS

WEL.L OE$TRUGTION APPLICA T,ION fC IH<IO-T8•1:J)

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Plezi;a desQIOO ITT dD111~: lltz propoi;ed du\M;l,lon i\lel,IO<I tA,iy 1Vlll ,Y')1l,ui;llcl) In \•.tiidl 1/ie-vtdl ca$l!1g itla!tl~,ple~ iincl 111 whlth 1heweU has a 1il!et pad: a'ulslde lhc> c:2$U19, m11s<ba de~troytd u;illil :ipplou.ei! nll\11~ g)cut): ' ' Nu( ~me~ tf0111'\lll lieg~ fatad!C\\'tll~i.tufocjli111.,..U ~toll\'<~ k'.lClw plial,3l!ldio=. r,$1.,;r lh:'<crra1bz< mr« 11\Uj\ln>uis ~lO roia.111~ t-.o ·ru:,v,LW1.tS A,:L\n11 i., 11Jfo4 ~f:tl~~-/11 tl>:(,ll<lCd C,W!>ln-'J.r,.in b::C>rt\11t11,u,I ill'l'll'«I cil).'lfl"I)'.

I und.-fe,,i!IO(ld egme lltm all wbtlc u--=l•lndw!lh IJva pmn'tt llt 1gqv\ed la~ clone.Ill ~t=wl"iC<>Yllill ~-Clb~ Vall6yWotor P!Glrl.t (tlj&ilk\) Well Ordllulo~ 110:,:ttu, Ois.llic(~;)ll.~dams,~ coiitfl!IW al !!ls~ (SM pajJ114), I Utfl(y !Jallholn~mw!lorl 11lvoo,[n. ~ P/lrm11 is:CDIT~ fo Ul.~be.st~f ffl)'1<~'kd.JC.and ,lhBI ll,\CM!JllillU1a•~11:l\'f, l~Ollilnal e~o~. O(J)flolocop.llld, Ts llulf!ortzea and valiCJ, an'dis ?,f~ 111111'!, the ~t~nlio'l)ji Clllor¢abl'e; La!'° =Ufy lha\1> t)bl ot' ~IOnCJOac:mianl'!I/JIWll~I lie!: baen f01n1~lf'l.ed betweM Iba Yi-ell 1iv111vanJ1 P(oflcey.rMIICf, it:patl~dll!ct, S.~IU!lwoo!W;S PM!~

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The Di?.Uitl Ila app·rove'.f Che fttlltiY,ing !lolslruc&in melhc)ds for Iha waU de.scribed lo.ihl~pcnnlt; X P~e Grout l'Kl,Qlod~a~ uu1iit>n,d ln'Sji,(ldord<i) o~NO-TE: ·Neatc:amClll ls lhe on~ s,e~4o9 IJl31.0•lal 11pprovecl f0( ~e QtouUng. A O{ Oriti out wall lq a ~C?lef dep!IJ of . S S',. 5 leiL with a mlll!mum boril ttf ---,---~=---- lir.f\es. □ Cl~ out i11Gll_~,1n:g (o a l<ll:a!.d~lb er _______ ~ iltwl blld< 1'ul y,i[h~Pjl/ovcd reallil,JJ'ma~md 'GI tolzit dnplh la

unlc'nown, dtill"rci,ut\ d4\enn,i\e lollll tlep\h durlog d v6n o11t.ofvn,IO, NOtt.: tit.I tc:mi!III i, ll,,r only •caUijJ n•nlcritlln~ lo< beck lilllng'gi':)\'Cl r,3·cbd w..,a,,. · ' tJ Well co:,lng mullt be parloraled al lhs fo~o,1hl9 depth$ pn:><' 111 'b11Qllfif111JJ; ___ _. _ ______ _

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WELL OE8_TRUCTlON APPUCA.TlON fC'19~jitMl!-10)

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;. :P!e.3$e c:ompiete ell lillonnatl0:n: DISffllOTPEllhVTflb.!· / 4 OtV~O we11:o,,,.11'1ir:

p~~0-"'11~ 1-h~lit llf~n~~SJ!e: \'boJl'OA11J!:G!ll~p,_lai:. l!1a1a OnC4,wy ,Rood, 4: Al,po,U Dcpil!lll"\ ~lll.ala.ci!tu.!tJIIlrp1t:1MY .. Well Ovx:rs Mallill!I /\ddre:s~: lilS ~ · ejl<Blvtl, M~ lOI ·

• 'f'Ri~'Gv11ctc).f~og~~ . IOI ~'Y)IOrl Dri,'l' Mdre#ofWtlf6Jlt; ' m.1:. 111.uU111 i.iA11d ~Cal ~ ~ianw> nl>llhc1.1tof 't?lCl•VlllaSt ~'ly. Sltft, 1Jp (;olY, ~,a\i. ~ •Clly, Slala, ,Z,p ~~.WA!l&2l6 . S"'Jo.><,CA!IJ'JIO >,tou:nt.illV.im, CA~C113 T&9lioi,o~; ~0PD1colllo. o!W;;iis'ii;: ..

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44U7ll◄OO - Book .w. Pl'90 ~ FarQ>I m. (l(;Jljl)ll111t O~Carnp•riy: .08&1

• ·t • • -~~.illll!laCQr.i~,,IDo Alldtll!'_,

• Add/~I ~~s Port Q,leai:,a ~ft)( SSO~l!....t Clly,Dl•lt,~ ~.~.zi:i 0.1.~.c;.1>.lSiO . RJaVu\f,~1 :i;i'~phoru, No.~ ~D116I~ • 1 c.&71:~"\lo..:

.91~t J&73TU300 1100n -0 ·chc,di II .-&fies& ot -ta!io,w humb\ll'hU c?pr,g'f!d 0 Cl\,ctchcklmu1t p&,~11Jllliblth1$d-,&lll)e0 ' i,, A11 qlloslf ons bolo\11 a1;1t t~ bo c11r11ple\ed before.pennll tt'n ~ leliuod: If unkhown, ~ppllcaot 4fi111 mlillo 0t1-t1lf.e rn11ei;tiga1fon u,

d,a!8fm!no, co!'t'«.~ 1111,w.on:. . • _

Thk'$ocdlonio Bl> CGalPlclcd 1<>r,Alf i\anllilll!ID WoU. or~nlRf;06~f!fyWell• CU11Mame/llh>.: • I QW...-;nµ.rl'lamoi: - t>r.'4~_S._tr __ ..,.,... Of«islQh\~oocy. I ~ -w~rnlc;)\l\~·1-1o7: 'JtPI\ . _ ifts.nUlU. Q Wp'll on Qbtlld.propcl~Al•t,p\iolll{ljOa ~~ilCWl!l'il\ E.)- " Wf/J ~cripGot1:

0 YafleoJWoB O 'Oa'M.IOl!nf-11/on O l!,\mlDl:Sl~ft. □ ~UipleOII~ 0 l~lalWall CJ PlWe!i Wc/1 T\IJ>~ Cchoc1<-.nlhalap~l)1: 0 We/ct PlodUdng D llor,iom~IJvt~ !<:111\lfp D ~:,itur.il .Q Do<n!ISlb · □ M~nk1pal.& lndl.lSl~I

(llu~p\y oi ~r&CO.,n) · p Vlll»C' e.,racllOn fiA 11.ofWlllnJ •· ti 'l~11iir 0 Otoulldvilller O Vodose □ P,fe~~~~f Q 1'1tedlc.. □ &Jdlo'n\.y.lmotet O ~ . tJ lhjecl!O/lllrl~allbn

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0 Co:cil~nl~\iol\011111\IIR O R«lam;<IW.-t•r 0 .iAlrS~ 0alll0dk1'1o/.aa!on • • -~-Ooq1h1t,•1Cllt\ll1tc!· ,. o~e,c.inal>Clot~·, • &Y~ 2. M liu',ar~t(ll~iil11dbrdo"of~J!til.bfa~ Ii V~ DI-lo a. Pdi.C.V.W.D. water-moior.al\9llllo4? 0"'1'., li!I ll'o 1ypi,oror101ru.1 ili11iri19 Maitiois: "{ij 114111.9' ' ·a ,~Tool b H~·DIIOPilWcl [J Ho04w8twmJ\~ □ Olllir. :ii.r,PQl-~-, 1:t~ r• ;, Y1,1niuu11n ~G-l11,~n :~CJ\•tl' .~,u=J h~· ~i\'t•I\ to 5.iflt,, Cl:-irii Villlc:;V;.,t~r D,~llic1 ;t,nf' !o :;,~,11~~ 1'i',~-1,;,)iJt 'll ~r-:>1 ~ ··· _;· . . r..:l?I ,,,lVO) 2l,!,,/f,U7", (;;(I 2fit,(') 111l',;;1• t11to~~• 1C• wc-,t~111.!_.1<i~f' · to o,ut:~!".1~ p~1m•t .:11,:pl 1:.!ll:m . .. _.

JOB COPY Must be kept on job site at all times.

,.

REJ~~!~!D S c.v.w.o. Permit No. 5tJ-/3()S-::J-,;)

WELLS '

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PJe.1m1 oat~ In -dld>n, ilif! p:_(1JY.!$CJJ ~~ mu;iop ~ • 1'114 des.'~11 h whleb aie woll eamg 111'-l"' i,13c!;:ill\d1n viflir.11 Uio .w« hi>~~ ll:itr;,:.,tlcOl.ljckle1)\t1~t.'I~ h'llJstl>od~edt~~ n~ACllefllQfflll~ ~,,-,n,;:i,t:Qiti-i~ll~~dbioliu . .....it~~;·Loa\>'<.~i'<li,;,rc.t«lltrlcu:rll..c&r.,.lit«i!,1,-,-.~h""''"'·~ .. o!5llu:lwJc,,11• iiaaJ:Sf,iS~v!lll>tfl&&~~:ir.lll',i;.!>Oed~"11<1,1\ll!l,o~1<dL:,,dl~otpNp,:d)'.

Thd Dli:'.dtl t,n~pralltll Ille W>!/ dewudioli h?~ r~ tfle ,..,~ (!,it«a,=d In (lilii,"!<llr\l:,· ~ .P~•(lt Gf.l!u\ S.I~°""' (2s <lUU111..I ~\ si.""1'.*l . i) t. N01E. Neal 0CIITl~-1$11w! ~ ce':atriii ri>a1e11bt trppro~ fo~-jY.enureiirollli,i-,.. .D~O\!'lvmDlo111l11tl'hlt.pO,of 2_'-f.~_5 fo'at,\.;;o,••-minl.-nU/l'lbo.,llf __ __.'.z3~---~~-0 C/c"~'•~c;u:ngt.Q11lot;d$!<,pl\ol _______ Jo~I ni1~1;/iH.t2111pplO\'isi~m:ilt~(if10tilldtpOJ,l, 1/~i,~, dill~~ dc;l!'J!nlm\'IOID\ci•P,lll dlli11>3 ~ cu( Ol'l,,o/l), "-NOT!;: Hr41~1,lr l~Ol'Qy'~ ~nlQpprtnod tof b!)d( 1111ii!,li'ti_•el.:d P• Qlted lllolls-, .

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San~a Clara Valley Waler Dislric<:J

5750 Almaden EXp,essway San Jose, CA 95118-:16S6 (408} 265-2600

► Please complete aU information.

Well Owner:

lbc Homax Gt"oup, JJ1c. -· Well Owner's Mailing Address:

Property owner. PClillS\llb Corridor Jouil PoM:fs Boa,d

Property Owner's Mailing Address:

1835 Billl~::}· lllv,l, Suilt lOl . 150 Swi Carlos ,We

Cily, State, Zip . City, Stal~, Zip P.ellingh11111, WA 98226 Snn Curios, CA 9~070

WELL DESTRUCTJON APPLICATION Fe 198 (10-18-10)

Page1of4

DISTRICT PE,,; Ni': O 6 ~ 5 z._ Name of Buslness/Re3idence ~1 Site:

Cal~n railroad rraol.:s

Addross ofWell Site: )(H Ca<lrc>Sl

City, Stille, Zip Mo\Jnlo.i.n View, CA 94043 ---- .. . ·- - --··-- . ··----- ·- --

lelephone No.: , Telephone No.: Assessor's Parcel No. of Well Sile:

360,733.9029 ):1756 Book ill P~o ill Parcel 12.U

Consullant Dnlling Company;

CD&.1 Woodward Drlllinr, Company, Inc

Address: Address:

4005 Pon Oill:ltgu Highw,y 5~0 River Road . City, State, Zip City, Stale, Zip Concord, CA 9452() R.io Vista. CA. 94571

--~- .. Telephone No.: Telephone No.: I C-57 Ucens9 No.:

9lS.2S8.:U74 707.3 74,4300 710079

0 Check 11 address er phone number has changed 0 Check If address or phone number has changed

► All questions below are to be completed before pennit can be Issued; If unknown, applicant shall make on-site investigation to determine correct answers.

v,iell Registration No.:

Ot:,'~C' WZ.t Fe e Well Gesing Deplh

57£5'

Owner/Conso~enl Well No.: J·l

Total Boring Depth:

62.5'

Original WeB Construciion Permit No.:

li' w,::- 3c-<; Well Casing Diameter. 2·

-----·

This Section to Be Completed 10r All Monitoring _W_e_ll_s_o_r_Ex_ lr_a_~ti_·o_nl_ R_e_co_v~e....:ry_W_ e_ll_s _ _______ _ ______________ _

Case Name/No.: Casewor'i'.er Name:

Dr. l,ynn Sutr

Oversigh! AgenC)•: !ll-'A

Ca,;ewo(t<er Telophone No.: 41~.792.3148,

D Well on District ptoperly/easemen1 (See Geneml Condition E.)

Well De1;criplion:

181 Vertical Well O Dewatering \'well O Elevator Shaft O Multiple Casing D Hotizonlal Wall D Pit Well

Well Type (ct,ecl: all thel ppply):

D Water Producing O Conlami~alion Cleanup D Agn::ultural D Domesllc (supp~• or e>draclion)

0 Vapor E>draction IE! Moniloring D lnciinomel~r

0 Piezometer D lnleJfac:e D Suellen Lysimeter

0 Contaminallon Cleanup D RecJaimed Water D Air Sparging

~ Ground,•,ater

0 Seismic

D Cathodic Pro1ection

0 Municipal & lnd~strial

0 Vadose

D lnjecikmllnflltrallon

~~B.1™&tw1~1@:ffi;;~~·~~fut$. Doos the well have: 1.

2.

3.

Outer condlldor ~sing? 18.l Yes O No

Annular cement S!!al outsl:lc of casing at surlace? [gj Yes D No

A s.c.V.W.D. water ml'!ter attached? □ Yes IEi No


~ ... Cable-Tool ■ - .• 'lo

IMPORTANT: A mini mu Ill 24-h□ur notice must bi:- given to Santa Clara Valley Water District prior to installing the annular seal. Call (408) 265-26D7, ext. 2660. Please ellow 10 working days to pro~::: ;--M"'•• <>~~t;r:,.tion. ·

~~~~~D s.c.v.w.o.

WELLS

SonlD Clara Volle~ Wok:r Disuic\6

57$0 Al•nr-rt~n Expr~sW:t)' l;nn Jnr,r., CA ~~l 10-3(-66 (~00> ic~ tC,CO

WCLL DESTRUCTION APPLICATION f C 10& (10-1 R·10)

l'agc l of ◄

.. Pi;,:.se d.;_;c;;-~~ d&lail, 1he pr1~o~cd ~lruc.tion ~0th.id (Anyw~II d!!shuelion In ,'lhich lhe well casing Is l9R in pi;e:; 0t~d ·,n-.. ;hid1 the wen' has i, fillur p11c:k oulsirlr. Un, ~u~h,g, n;usl 11P. de~lro:,ed usir,g »JlP"l"e<.l nP.111 cP.manl grm:1):

t-(c.J1 cem.1S1 g,o-.r. w)!I t1r p:.i:nped into th~ ""r.ll c.:...\ingit~111irit, finn, wc:11 'hau.or: \t rin rc-c:l bduw pound wrli11::.c. >Jt~l~ t("fflCO:J hM sr.: iil: A min~a\bn of lOm!nu!L.'. llit ,cm>lnllll,) (e<.I will b, nu~..d wllh (OlltlttC AU <ih9!1<.ed tJoonll,..., .... ill !"'t<pa:,<J .., .. , ~j .. ~o,ru ur, .. v-•I~.

~ -~.,. ... _, -~~- - ~ :Tu;fu: ;;!:!•·~--~~ -~~"'""'" .. ™.§!"/~~~ ~~~m..~;~-~ ~&~:.{i~{~~i'¼"~~~~~,,.·~~; ~ · ~~mt~-M~-~~~1-.. ~~HWb1¥~~~~ · .'ii«tt!~~h~~-' und~rsland and agree lhn\ ~II work associale(I w11h thl:! pcmiit lz rcqulrotl lo b(; do110 in acco.danco lliilh S;inla Clam Valle)' Waler Dislric.l I (Oitlrii:1) Wttll O.· rdi11ance 90-1, uu, Disllic:IWeO Standards, and conditions of 11-Js perm~ (see pa~ 4). I certify !hat Ille inlonnalio11 given in tills pcrmil ls-corroel lo !ho liP-SI ol my knowlccgn and lhal the sign111ure b~low, whether 01iuin~f. ele<..11111jc 1 11r pholo=x>plcd, I~ .iurhu1lzed end .,elio, 1!.rv.l ls aflixecl with lho mien! lo h11 onlorcoable. I also OOl1lfy lhal a right nl enlry/encroactimenl allrecmenl has tmcn fanna!iied behYean Um wt:11 owner 1111<.I property ow,v;r, if pn11i~> dlt:ot.

S•9na!UIO of W1tO . • er/ Ml: - . ··:P_M __ ,-~-,3-,...,;----·•- .. -.----·--ro;.·1~'.- I

. ffss 0.A?'-"'..11:'.:..._ / ~. ({_-f_.'f_~, s•~r&G.!VIC- c,t Propony OWU\1lll1yai1I

~\1 -f'>~.. o.,,v----· ---------... . s,,nature ol l.lnll~r11111or.r.

-------[IZ.~,~--t_;.,.,_l_l_~_.,;_ i/./._1_+_J __ : : I 1 I IF

(·: ~ • r.. . ~ . , I· , ·l '1· . -. - . ,~_. I ·,. . ·1 . ,.. ri . ·. '- )) ,C.t- 1.:i~ • ..Jt9 .-.;{ 1.!.11L1 (;;. ·--~-l!.u.U~\ ... .L. ,lt:L!..C!l! .. M.• .. S

s~~~~~v~~~-(: _ !r(i~i V~l/lJP6 ~ ~"'\k~ . "" • ~ }~tg~~~fflil~J~~l'I!~ . · - <~ , ~ . - , <K ~e'~~-~~1- -.

L· -, --~: ·- ,.:3 ~ _, •••• -- - ~_;o.._ ________ __

O~lc:

lhr, Distrd h?.& armr,wP.d !ht; fol•c,"""!I d~slruction rnolhods ror Ille well described in rhis perrnit;

)( PrcM1Jrt; Oroul Mr;:nr,d (ar. c,utlinocl ir, St:ond~tch,) NOTE: Ne.11 cenien\ i:: the ooly Ge:111110 maleii:il ap;i4ovcd ror pressuro grO\Jting

'j4,. Dri!f ov1 well lo e total deplil of _ Gt. 2. , . ·5 feet, with a minimum borr. ut 8 □ Clean out well c2sin9 to n tC11;t1 lit-1>th of _________ lnet Hllll har.l. till 'MIii ;ippmvnd sr.al,nfl mot,,ril/1 (rl total dc,pth 1~

unknown, dr111or mm:t delermlre tolal doplt. during dean oul olwr.11). NOl E: NM! camenl is lhe on~• sealing mate1ta1 approved for 11;tcl( tiling grav11I packed wous.

□ VloB =~Ing rnuGt b~ pr;rlnralcd nt 1110 loilowioil doplhr. mer lo backfiilir,9:

0 Olhcr. ------- - - - - -- 9

. ---·----___ .,,,, ___ -·--· ~-?e,m'.1/lpprowd riy:

Sonto Claro Valley Wale, Disltic()

5750 Almaden Expressway San Jose, CA 95118-3686 {408) 265-2600

... Please complete all information.

Well Owner. The Homa."\" Grou11; Inc.

Well OwTle( s Ma\llng Address:

Property Owner.

fCllinsula Conido1 foinl Powc.-s Board

Property O.vner's MaWng Address:


DISTRICT PERMIT NO.:

FC 198 (10-HH0) Page 1 of .o\

t'1/JDO 3 " Name ol Business/Residence al Site:

caltnwi milroad lr3ck!

J 83~ &rl:Jcr 81\•d., Suite 101 250 San Carlos Avt Ad dross or\Vell Site: ,,l!J,./

1~1 /U~/0 //!I.e... s f-City, St;,te, Zip

BcllinEt,am, WA 96226

Telephone No.:

360. 73).9029 x27S6

Consultant

CD&I

Addren:

-tOOS l'M OiiCJISO HiglnY3y

City, Stale, Zip

Concord,. CA 94520

Telephooo Ne.: 915.288.2274

0 Cheo< if add1es.s er phone number has changed

City, Stale, Zip Sa,, CAJ!os, CA 94070

Telephone No.:

City, State. 7Jp 1

Mount.a.in View, CA 94OH . A.!;sessor's Parcel No. of Well Site:

Book ill Page Qi

I OriUing Compan : y WO(ll)ward Drilling Company, lnc

I Address:

5SD Rive, Road

City, Stale, Zip

Rio Visu, CA 9~571

, Telephone No,:

707.314.4300 C-57 License No.:

7)0079

0 Ch1>ck ir alidress ;;;-phon1> number has changed

Parcel IJ,tf

► All questlons below are to be completed before permit can be issued; if unknown, applicant shall make on-site investigation to determine correct answers.

Well Registration No.: OWner/Consuk&nt Well No.: OdglnQI Wen Construciion Permit Ne.:

0lP6 0iA--(p J..J rO'?JO E.W-7 WO CJ 7lL, Well Casing Depth: 64 '

T olal Boring Deplh: 64'

Well Casing Diameter:

6"

Thli-. Sac:tion to Be ComplBtOd for All Monitoring Woll1> or Exlraction/Rocovory Wells

Case Name/No.:

Oversight Agency:

F..PA

D Wall on District property/ease men\ (See Goni,ral Condlliori E.)

Well Onscripllon:

I Caseworker Name:

Dr. Lynn Suer

: Casewnrlcer Telephone No :

; 415.792.31 4&

181 Vertical w .. 11 D Dewatering Well O Elevator Shaft D Multiple Casing D Horizontal Wan D Pit Weil

Well Type (c:heck all thal apply):

lg] Wa1er Prod1-1cing b Contamination Cleanup O Agri::uffural D Domi,sllc (supply or e)(lraciion)

0 Munleipal & lnd11slrial

D V11pot Extraction D Monlloring D lnciinome\i,r C8l Groundwater O Vsdose

0 Piezometet D Interface O Suction Lysime1et" D Seismic. D lnjectiorvlnfiHralion

D Co11larnlnation Cleanup D Red aimed Waler O Aif'Sp11cgl119 0 Cathodic Protection ----~4i~lvt--. Doss the well have: 1. Outer cimduc:lor casing? · @ Yes O No

2. Annular camenl seal outside o: casiog at surfaa,7 ~ Yes O No

3. A S.C.V.W.O. waler meter anadled7 0 Yes 181 No

Type of Original Drilling Mi,thod:

[gJ Rotary D Cable-Tool . - .... . IMPORTANT: A minimum 24-hour notice must be given to Santa Clara Valley Water District prior · rn, 11 · '"I m., inu•a SH .,

Call (408) 265-26D7, l'XI. 2660. Please alloVJ 10 working days to process permit ar.•pl ; - •· , 1.

LIJ 111:.1,

, .. -.•

APR 2 S 2014

S.C.V.W.D. WELLS

Santa (Iara Volley Wo!cr Dislrict6

5750 A.l•IIMlr.a l!"f,rcs,way f.nn Jr.••· CA 9!>\ 1C-3{-66 (~OD) 2C~ 2C•C-0

WELL DESTRUCTION APPLICATION re 10a (10-1 R-101

l'~gc l Ill 4

-···--· - ---- ·~··- - -·- ~- ·- ·-··- ·- ·-- - -f'l1:c11-e dr..se1il,~ in dt.lail, lhn (l(of)osud tktltrvc.1ico melhod (Ally""'' dcslni.:liM In which lhe well casing ls l~fl in place nnd lo whi::h 1he well ha$ a flllot pnc~ oulslrle \ht, t:ilsillg, n.usl llP. e1e~lr0ye<1 usiny 11ppr0ved ner,1 cr..ml!nt grout} :

l'lwl oc,,.,,,, :;,ourn !I hr P" '"P",d i111o<l1• ... i, C.,.(~ Jbilint rrnn, .... , ""~ ... lt· r, .. l'ttl l>clow vnund "'"""'- Aflc:r 11-G tollCIVhll Stl ,;,, A miniM .. ,, of30 n,;..u:,,.., 1110

'""~"Ult> lc<.1 w1,1 b: ~11:-.d I-di~ "''"''" .~ ,\U 4h~IKcil fJUUNl""'" ,.,,1 !'<•,qs11<J .,.,, di-t""""' 11r1••v.1ly.

~:-:\':.,. - -·~ -· ,.. ·"-m:'"'' .... w.i~~~~it,, ,,..-·~--w..~~~~;..m.r~~~·-=-~ T~·1j;M;~~{~~fBi~~%½~~:1:!~ll.tAf1& ~~-.r.:~mWi'.t':~lt%'ifaiwT~~1~{~~~-~~~';!,!m~~-I unde,stanrl and agree that a111'.ork associalc,cl with this pcm,lt l!l rcqulrod lo bo do110 in ac::orda.nc:owilh ~n(a Cla1.l Valley Waler District (Dislfici) V•lell Ordinance 90-1, 011, msllicl Well Slanderds, and cond!Uons of this pe1ma (see page 4). I cettif)' lhat lhe infonn111ion given in this pormil 15 oo,rect to the best o1 my 1-'.nowtocsn and lhal 1h11 S!gnauire below, whether crigin3l, elt1<.111nic, c, pt,010::vpted, Is 11u1hurlzec1 arnl

11alici, and Is 11ffii1eli with lh~ rtllent lC1 h~ cmf01ceilblo. I also ool1Jfy thal A righl nf entry/enctoaehmenl a!}Tecmeot ha& btlnll formalized belw9An

u,., ,vc,11 OW11P.r "'"' propenr owner, ii porti?, differ. ___ _ ---·--~-----..... - --·-----,

Signa\uro of W11A ~ -aa-nn. -1:1: /J - . ... , • A . . , Ptinl 1-ll,no; • O~to: 1 1

-~ : ?ts~- Cblti1~N 1--'~-i]-1-J Sl)1'13!uflr ol PIOPOllY Ow1101/l,y""' Print Nn ,,.,.,, I Oaro:

~t M .- (J,,,_,v--- ____ A wn-111,,., 6cJW{,I-;) 1 / 1 Irr-$i~n:il,'f'C of Orillc:r//19ur.i-. ~(..,: Nnnw: Oat<':

. (\,:'),,~~"'·>'~,. c ..... J.~).•klihi' •~ d .. J:,,v\,~.1.iJ~ .... .'L!l'c~~d.0~\.f.Q __ !:.;,: ( ~. - 10 __ _ s~n~Jll ~V~uc•ll ur IJ~•): 7 "(2;i v~ lA)P6 rzu Ou= -Ct _

10 r V\ 7 ~~~~-" - •. ·' · .. · , . , ., .. ~~·~ ,. , ,:.,;._ ,mi .

The, Distri~.t Ila& i'tfl/llOVP.d It,,,; ir,l'r,wi()g dc1lrvdion methods lor 1he well described in U~s permit:

~ l'reMuro Crout Mt:\hoO (oo ouUonod in S\,ar11fa1d.c) NOTE: Ne11I cement is lhe O!'l ilt se;illn~ m:iteiful approved lor pressure grouting

A Drill 0111 well to a lotel depth of - - - -~ ~ .. ____ feet. wilh II mioirl'l\,m borP. of / ::z__ lrichei;.

0 Cl(lan out well c:asi119 10 11 IN;.I lltl'lh of •--------- lcr.t ann harj. loll wolh nppn,11cd S!?illlllJl matCtiul (111olal dcp!h is

unknQwn, drlllcr mu~! delermlre 101at dcpll1 during delll!I out clwtK}. NO r F.: Neal cemenl Is the only scaling matellal apµrovad for bacJ< ming grav11i pecked wells.

------- ----------a~ D3I~ /t /; '-/ ni:,told Pcmill No.: / O,i~'az.t/ 58 i--•·-

Santa Gara Voll8H Waler Disbicto

5750 Almaden Expressway San Jose, CA 95118-3686 (408) 26S-2600


Page 1 of4

► Please complete aR info,mation. 01sm.1cr PER.,1r No.: I .:3.DO osfo 1 . Well Owner:

Toe HolllIDC Group, Inc.

Well Owner's Mailing Address: l 835 BarlJcy Blvd., Suite l 01

City, Stale, Zip

Bellintil1wn, WA 98226

Telephone No.: 360. 733.9029 x2756

Consullant,

C.BH

Address: 4005 Pon Chicago HighW8)

C lty, State, Zip

0.111c.1rL1, CA 94. 20

Telepllone No.;

9..5.288.2274

0 Check if address or phone number has changed

Property OWner; H.M. Anthony Marital Deduclion Trust. Name of Business/Residence at Site: Carol Jean Anthoay, Trusu:o Former Jasco Chemical COll)Oralion

PropeityOwner's Malling Address: Address or Wall Site: 33 t Cypress Point Dr. 1710VillaSt

City, Stale, Zip City, Slate, Zip Mountain Vic:w, CA94043 Mounlain View, CA 94041

Telephore No.: Assessor's Parcel No. of Well Site: 650.961.0207 Book IB Page Q2

1 Drilling Company.

Woodward Orilliua Coaipliny, Inc

Address: 550 River Road

City, Slate, Zip Rio ViSDI, CA 94571 Telephone ND,:

707.374.4300

C-S7 License No; 710079

D Check if addl'9$s or phoi,e 11urnber has c;l:1'1J'19ad

Parcel ill

► All questions below are to be completed before pennit can be Issued; if unknown, applicant shall make on-site Investigation to determine correct answers.

Weil Reg;stralion No.: Owne(/0,msultanl WeU No.: Original Well Co slru"lon Permit No.: o & 0o:i.w-21 r-= o ;i_ r I

EW_-6A ___ ____ ------=&_,///._'tJ_o_.::z_,~s-_ _ _ Well Casing Depth: Tol~I Bo(ing Depth: Well Casing Diameter: 20· ' z.o• 6"

This Section to Be Com~eted ror All Monllorinu Well!. or Extr.ictlo·n1Recovery Wells

Case Nama/No.:

Oversight Agency; EPA 0 WeH on District proparly/easemenl (See General Cond~icn E.)

Well l>escription:

CasewOfker Nama: ' Dr. L)'llll St1er

I Casewofker Telephone No.: 415.792.3l4B

[81 Vertical Well O Dewatering WaU O Elevator Shaft Q Multiple Casing O Horizontal Wall O Pil Weil Well Type (check all that appty);

['ill Water Producing O Contamination Cleanup (supply or extrac:tion)

0 Vapor Extradion

0 Piezometer


Does the wall have:

0 Montorlng

0 Interface

0 Reclaimed Water

1. Outer ccnd uctor casing? ·

0 Agricultural

D Inclinometer

D Suction Lyslmeter

0 AirSparging

2. Annular cement seal oul&lde af cesing M !:ur1aoe?

3. A S.C.V.W.D. watermetflraltllched?

Ty~ or Original Drllllng Method:

0 Rotary O Cable-Toor O Hand-Dug Pit Well ~ Hollow Stem Auger

D Domestic

181 Groundwater

D Seismtc

0 Yes

~ YI!!!

D Yes

□ Olhi,r:

No

Na

Na

D Munli:l::ial & Industrial

0 Vad0S8

D lnjet!ion/lnfiltratlon

,IMPORT ANT . A minimum 24-hour notice must bEO gi\'en to Santa Clara Valley 'Nat.er District prior to ,nstal l1111,i the annular seal , C:it l (408J 265-2607. ex t. 2660 Pleac;e allow 10 work1n~ d,iys to proc e;as pti'rm,: appl1c;;it1on

5anlo Clara Valley Waler Dislricto

5750 Almaden Expressway S211 Jose, CA 95118-3686 (408) 265-2600


Page 3 of4

Please describe in detail, the proposed destructlon meU-,od (Any well destruction In which the well casing is left in place and in which the well has a filter pack outside the casing, must be destroyed using approved neat cement grout):

Keat ccmcr.t grout will be pnmpzd into the weU :asing swting from well bouom to five feet below ground surface. Afior the cement hi!S set for a minimum oOO minutes. 1he remaining S feet will be filled with coocr~tc. All displaced ~011ndwu1c:rwill be captun:d aod disposed of property.

I understand and iigrne that all work associated with this permit is required to be done in accordance wilh Santa Clara Valley Waler District {District) Well Ordinance 90-1, the District Well Standards, and conditions of this permit (see page 4). I certify that the infonnation given in this pP.rmit i"' r.orrect lo the best of my knowledge and that the 5ignature below, whether original, electronlc, or photocopied, is authorized and valid, and is affixed witi the intent to be enforceable. I slso certify that a right of entry/encroachment agreement has been fcnnalized between the well owner and property owner, if p~_rt_i_es_d_iff_e_r. ___ ____ ..------- - -------- --.--Signatura cf Well Print Name: Date: _/ ~

/~S'S" CMtt-501\/ f//:;:_.75 Print Name: Date;

7-;}.~-J 3 Print Name: Date:

C~_(J '1 '~C ~ 1\..~ • ' ? . 1,:($'1j,(lU.kvt-C

Signature of Co11sullanV !ml(~ any):

,, -) \ ' .... · , -,l ·(11: 11 cc~ !, - -- I ~; . , :) P Int Name: J Oat;:, I i!f 11 ~ f'Y'' (:,..,,~

~.

~ Pressure Grout Method (as outlined in Standards) NOTE: N~t{f.ment is the only sealing material approved for pressure grouting.

p Drill out welt to a total depth of J_ C> feet , with a minimum bore of ___ /_2.. _____ _ Inches.

□ Clean e>ut well c;asing to a l0tal depth of _ _ _ ______ foet and back fill with approved sealing material (if total depth i:. ~nknown, driller must determine total depth during clean out of welQ. NOTE: Neat cement is the only sealing ·material approved for back lllllng gravel packed wells.

□ Well casing must be perforated at the following depths prior to backfilling:

D Other:

Permit Approved by:

D~bid Permit No. ;

l J

,I ,. :;

ATTACHMENT 2

DWR WELL COMPLETION REPORTS (DWR 188 FORMS)

'The free Adobe Reader may be used lo view and complete this form. However, software must be purchased to complete, save, and reuse a saved form.

File Original with DWR State of California

Well Completion Report Page 1 of _1~3'---- Re/or 10 l& t,i,cl/un P.3mph/ot

Owner's Well Number .... 1-_1____________ No. e0229483 L .

Date Work Began..Q511:2tW4 QS"'-!:)•l"l Date Work Ended .a:5'"'/1.,.5""'/2.,.0'--'1"'"4 _ __ _ Local Permit Agency Saota Clara yaHey Water Distrjct Permit Number 14D00352 Permit Date 4/29/14 APNfTRS!Othor

Geologic Log Well Owner Orientation 0 Verllcal OHorizontal OAng(e Specify Name The Hornax Grou12

Drilling Method Hollow Siem AU!lCI Drilling Fluid Mailing Address 1835 Barkley Blvd., Suite 101 Depth from Surface o,serlptlon

Feet lo Feel Describe motnrlaL oraln s110 calor. otc Qllv Bellingham State~ro 98226 0 5 Concrete Gap Well Location 5 63 Portland Cement/Premium Gel Address Near 1710 '.iii~ S!reel

Cily Mountain View County Santa Clar.i

Latitude N Longilude _________ w ~ ~ ~ OO<I. Min Sec.

Datum Dec. Lat. Dec. Long .

APN Book 154 Page 04 Parcel 013 Township Ranae Se.Cllon

LocaUon Sketch AcUvrtv !S.~olch '••uot bo d•"""' b\o hOlld ftfl<l r (r.nft lo nn,,!Jld,I 0 New Well

North 0 Modification/Repair 0 Deepen 0 Other

® Destroy Oo,;.crioo otoeciduros and rna1enalti Uf'ldm ·GEOLOGIC LOG'

Planned Uses 0 Water Supply

iii O Domestic O Public

.;; □ Irrigation D Industrial Ql .,

;: w 0 Cathodic Protection 0 Dewatering 0 Heat Exchange 0 Injection ® Monitoring 0 Remediation 0 Sparging

Souin 0 Test Well

lVM!!.111U ~ d(llit:nbo !11:r.t□nce of well rmrn ro.1'1s tlui!Clin!JS.1~ 0 Vapor Exlraclion

m'IJr.i , ate . and dJtach a map u~ Mdlllorral ~'1'!' II noc11~ary 0 Other Ple»• b. .-c,uu.11i 11r.d l c,n,01111•

!Water Level and Yield of Comple.ted Well Depth lo first water (Feet below surface) Depth lo Stetic Water Level (Feet) Date Measured

Total Depth of Boring Feel Estimated Yield • (GPM) Test Type

Total Depth of Completed Well Feel Test Length (Hours) Total Drawdown ___ (Feet) ·Mav not be reoresenlatlve of a we(l's Iona term vle!d.

Casings Annular Material Depth from Borehole Type Matar/al Wall Outside Screen Slot$1~e Depth from

Surface Dlamalar Thickness Diameter Type if Any Surface FIii Description Foal IQ Fuel (Inches) (lnc;hesl !Inches\ /Inches\ Feel 10 Feel

Attachments Certification Statement D Geologic Log I, lhe undarslgned, certllrr that t11ts report Is complete and accurate to the best or my knowledge.and belfef D Well Construction Diagram Name Woodward Ocil [og ~o. Inc

11cnson, F/1111 or Cotllll'l\Tlan D Geophysical Log(s) 550 Rivsr Road RloVisla CA 94571 D Soil/Water Chemical Analyses

Signed{J.1'rll"Jv~ ~l );,_ fiJ-mr:/i..~w. .~11 8/28/14

Stolo Zip 0 Other Permit 710079

Anad1 ac.lditianal information ir ii exiSls C-STLiceoll<!d Wm'1 Y104 Conilor.1or Date·Siqned C-57 License Number OWR 1B8 REV. 112006 IF ADOITIONAI. SPACE IS NE.1:P~ NEXT CONSECUTIVELY NUMBERED FORM

"The free Adobe Reader may be used lo view and complete this form. However, software must be purchased to complete. save, and reuse a saved form. FIie Original with DWR Stale of California 0WR Ute On! - Do N111 FIii in Page _1 ____ _ of _4 _ _ _ Well Completion Report

Reier to lnsrrvction Pamphlet Owner's Well Number 1-2 No. e0226153 Stnte Well Numbcr/S1111 Number ,r-- --.-1-t -'i\r-'--'1""'-'-rl'-c;Ni I I I I I I )wl Date Work Began G§l"~iJQ.:14 Ql\•ll•\~ Dale Work Ende~Q\•U. I~ Local Permit Agency Santa C!ara YaUey Water pistrjct

Lnlltwse lonJJill.ide Lei I 1 I I I I LI

APt,lfTRSIOthtu Permit Number Permit Date

Geologic Log Well Owner Orientation G>-vertTcal OHorizontal OAngle Speclly Name Ihe 1-tomax Groue Orilllng Method tloi!0w Stem Auner Orllliilo Fluid

Mailing Address 1~ Barklel!'. Blvd., Suite 101 Depth from &ufaco Dascrlptfon Faot ID Feet DcsQribe-m11tor.lal, aroJn iw,, eoJOr. 11tc Citv. Bellingham Stale ~ IP 9~226

0 5 Concrete Cao Well Location 5 60 Portland CemenUPremium Gel Address M!iidi2n Qf-Ceotral !;;XQ(e~~~ NI;; 171Q Viii~ Street

Clly Mounlaia View County Santa Ciera

Latitude N Longitude ___ ____:;v Dea~~ DeQ. Min Sec

Datum Dec. Lat. Dec. Long.

APN Book 154 Page 02 Parcel NA TownshlD Ranae Section

Location Sketch Activity I~ muil lKl.chWII DY llilnCIMM' ronn IC onnlfl~I 0 NewWell

North 0 ModilieatloJ'I/Repalr 0 Deepen O 0 thei -

® 0eslrov, ~ .P'~l~.,.tNWI• """" 'GelX.ollkUOO•


-

□Domestic □ Public 1;j 13 D Irrigation D lndustrlal l w

0 Cathodic Protection 0 Dewatering 0 Heat Exchange 0 Injection @ Monitoring 0 Remediation 0 Sparging

South 0 Test Well

l&luetrall! or dncribe ~Ulnt.ci of"MI fl'OCllfOIIM , bulkrlfl!JI, (e,\CH. 0 Vapor El<traclion

,,..en • tc arid altach • m.ap UH 1dlflbon11l paper II nccas3a,y. 0 Other P\a.ue ba ;a'-c;ul'IM .-.cf <'Ol'l'mlll•

water Lovet and Yield of Completed Well Depth to first water (Feet below surface) Depth to Static Water Level (Feet) Date Mea.sured

Total Depth of Boring 59.5 Feet Es~mated Yield • (GPM) Test Type Total Depth of Completed Well 54.5 Feet

Test Length (Hours) Total Drawdown ___ (Feet) ·Mav not be represe.nlallve of •a well's lonA terrn vteld.

Caslnas Annular M.aterial Daplh from Boroholo Type Material Wall Out.sldo Scn,qn Slot Si¥o Dop01 rro·m Surfaco Diameter Thickness Diameter Type if Apy Surface FIii 0escrlpUon fool lo. Feet llnaho~\ llnchtl:!ll nncnei\ llncho&I Feet 10 Feet

Attachments CertlflcaUon Statement □ Geologic Log I, the un~ersigned, certi~ that tltis report is complete and accurate to the best of my knowtedge end belief D Well Construction Diagram Name Wog!;!.warQ Qril ina Qg. Inc ·

Person, Arm or Co,porbl!on D Geophysical Log(s) ,:;r:;o Riv"'r Rn<>rt Rio Vista ..Q.L 24571 0 Soil/Water Chemical Analyses ff JhA ... -...<lllro» •~ City State Zip IZl Other Peqnit Signed _ --~-&. It ';, >nA,,-/ 817/14 710.078 "AIIIICI! eocsmon:11 1t1r~<\llon Jr.rt A~••• C.57 Ucl!.M'ed W411» Wa'l Coolm"or Dale Sianed C-57 License Number DWR 188 REV 1/2006 IF ADDITIONAL SPACE IS NEl:DED, USE NEXT CONSECUTIVELY NUMBERED FORM

•1·;,., free Adobe Reader may be used 10 View and r.omplete lhls rorm Howewr. software mus1 be purchased to complete, save, and ieuse a saved form. File Original with DWR State of Califomis DWR U:.o Onl - Do Nol AO ln I _:i,_ Well Completion Report IO, 6, s I 0 12 ,tc..1- ;}, l IC l ~ 0 1 ~ 71 Page of r-~ R;, ,o 1nw,1r:i:on P,m~ Stnto ell Number[Sltb Num~ ..-Owner's Well Number

t~18505 I I I I IWI C(J,, ''""' I I [ill I J I I I I Date Work Began Dale Work Ended Gitliudo Longlludc Local Permit A9ency 5 C: e,., "-0 [ I I I I I I I j I I I I I I Permi\ Number f ~ t2tJ>,O !l,tt:>9" Permit~te ~ ~;_o - t.~ APNfTRSIOiher

Geoloalc LOIJ Well Owner Orlenlatlon 'flJVerllcal OHorizonlal OAngle Specify Name•'-• U- -. - - g...,__,,L)

OrUnno Me1hod OnUlng Fluid Malli~ A(1dre55~ ct< ~1 • .i 6.v..l ~ .• rt. tcf Depth from Surface Oucrlptlon CilY • I\ ' • k.. ...._, I

State J...JA.z10 rm.._'].."=:i Feat. ID Feo1 -~ Ll1!$trilio 11101u1131. a•al••a-lte cute>r. etc _o ,:J.... ~)\ ,;. r l:..c)J~, ~~c.- Well LocatJon _.,.5_ 1.,.. .: .__ ~.v\'V~ Address'1,J.:• ........... t ... l ,J [;,.-fr~ l e. ., "' ., lJ£.,(' Ola Vi\"-. st - - j{...., l~ ... A-\t- 1. er~...._~ f?,,.._ · -~ ~~\ C!tyMn.•-'-~·A \l, w) ~

I

Count .'".. ½. CJ4.,.. I < Latitude N Longitude __ --~ ~ ~ ~ Dea. Mn. Sae. Datum Dec. Lal. Dec. Long. APNB~k 6'f Page _ C,Z< Parcel NA Townshlp Ranae Section

Location Sketch Activltv ISknld1 n'll!l bu.d/lrM bV han~ ·ollcr tll(ffl 1s orinlll<i,I 0 New Well Ncrlh 0 ModlficationlRopair OOeepen 00lher

~ Destroy o..c:ntJD pnxitdLro, er-d rna~lt ln:ler"G£0lOGIC::: t.oc·


D Domestic D Public .; 1 D Irrigation O lndustrtal ~ w 0 Cathodic Protection 0 Dewatering 0 Heat Exchange 0 Injection ~ MOl'liloring 0 Remediation 0 Sparging

Snuth 0 Test Well , .. ,,, ... ., ___ cil_ fft,,n ____ 0 Vapor Extraction ~-:::.:='1:.~.. . rt4DPt CtpKOM ,Y, 0 Other

Water Level and Yleld of Completed Well Deplll to first water (Feel below surface) Depth to Static Water Level (Feet) Date Measured Total Depth of Boring --=r-1 Feet Estimated Yield • (GPM) Test Type

Total Depth of Completed Well Sf,, Tesl Length (Hours) Total Drawdown ___ (Feel) Feet 'Mav not be reomsentallve of a woll's IO{IQ terin Yield.

Casings Annular Materlal Deplhlrom Borel'IOIII Type Materlal Wall Outside Screen Slot Size D11plh from Surface Ola1'1oter Thickness Diameter Type IIAr'ly Surbco FIii Description Fool to FrlCII llna~l llnchesl IIIIW!ISI (Inches) Foot to Feet

Attachments Certification Statement D Geologic Log I, the uu_~~cel1~ "->~s ~J~rpltlle ent,1curyte lo ihe best of my knO'Ntedge and belief D Well Construction Diagram Name ,. ,-ll'lr.. · . nr ~·re~~ll(•-A-- 1/.i '7~ ,lt:\t6-. qlJ67l D Geophysical Log(s) ,, J •r; vm .QA_ D SoiLWaler Chemical Analyses

Signed U,,.. ~I ...Add~g ..rt 1, 1.-.I 1 ,.,_ _,,I Cly flA h S1i1, Zf~ D Other

1-k/4 ~'~~ J\ljot:n odd1110<uit ntocrn.b'on ~ ~ "-"•to. C-!i 7 lkOtJ611/ Wainr W11.1 Cotil/ncl!>l Date Slnnetl C.5ffierT"'"7oor DWR 188 REV, 1/200e IF AOOITIONAL SPACE IS NEEDED, USE NEXT CONSECUll\/ELY NUMBERED FORM

•The free Adobe Reader may be u98d to view and complete this rorm. However, software must be purchased to complete, save, and reuse a saved form. File Original with DWR State of California DWR. Use O - Ob Not FQI In

Well Completion Report Page 1 of _4____ R<ilos lo 1mtllld/on ~amphtet Owner's Well Number _E_W-'-~---------- No. e0226157 Date Work Began 05/12/2014 Date Wor1< Ended -=5~/1,..5.._/2.._0,._1.._4,__ __ _

I I I I I ~---~s .... ta_te_W ...... el_l _NurnberfSJte Number I I ·, I Nl I I I I

t autuda Lonoltudo )wj

Local Permit Agency Santa Clar.a vauey Water District Permit Number Permit Date APN/T~S/Othor

Geologic Lo11 Well Owner Orientation ®Vertical OHorizontal OAngle Specify Name The Homax GroYQ Onlr.ng Method Hal low Stem Au110< Drillln11 Fluid

Mailing Address 1835 .Barkley Blvd0 Suite 101 Dopth from Surfa~ Description Feet 10 Feet Describe material 11.1111n i lze cotor etc Cllv Bellingham Stale-~iD 98226

0 5 Concrete Cap Well LocaUon 5 24 Portland Cement/Premium Gel Address lZl.0 Villa .§!~et

City Moyntsill! Vjew County Sanla Qtara

Latitude N Longitude ____ --Y'J Doc~~ DeQ Min. See.

Datum Dec. Lat. Dec. Long. APN Book 154 Page 02 Parcel 001 Townshlo Ranae Section

Location Skotch Activity (S.~e<c:IJ f™OJ Do _, D• hand ollw ronn ias onn11><1.I 0 New Well

North 0 Modification/Repair 0 Dee:pen O 0 ther

® Des.(roy OHCfibe pro~~u,os and m•t•r1•1s 1.mder "GEOLOGIC LOG'


;; ;; D Domestic D Public

~ ti] D Irrigation □Industrial 0 Cathodic Proleclian 0 Dewalering 0 Heat Exchange 0 tnjectlon ® Monitoring 0 Remediation 0 Sparglng

Soutll 0 Test Well

l1ildlt11hr or iteacnbe diston1:.ror ~~or.,~ tiu.l&oop,. f11P1ect,, 0 Vapor Extraclion

rN~tll, etc, and aflaCfl ill m■p- U.1,t :a.dl111ti'W paper htlkc:UtfY, 0 Other ft1ruMbe ■~M\4ca~t• ·· . Water Level and Yield of Completed Well Depth to first water (Feet below surface) Depth to Static Waterle11el (Feet) Date Measured

Total Depth of Boring 24 Feet Estimated Yield • (GPM) Test Type

Total Depth of Compteted Well 24 Feet Test Length (Hours) Total DraWdown ___ (Feet) ·May not be represenlaU11e of a welt's rona term yleld.

Casings Annular Material Depth from Borehote Type Material wan oui.tde Screen Slot Size Depth from Surface Dtamatar Thickness Diameter T1pe If Any Surface FIii D111crlption Feet 10 Feet /lnchesl (Inches) (lnellesl /Inches} Feet 10 Feet

Attachmonts Certification State_ment □ Geologic Log I. the underslaned. cartl~ that this report is comptele'and .accurate lo lhe best ot my knowledge and bell et □ Well Construction Diagram Name WQ!iJ_:i!'.ard Drll Ing CQ. Inc □ Geophysical Log(s) Per119n, F,rm "'Colporall<>n

:i50 Bl11~r Ro2!;! Rio Vis!!! Ca ~~J D SoilMfaler Chemical Analyses I, l'o<latOJJ Olly siiiit 1.,p 0 Other Permit Signed ~"~ I/! ~,~ 8nt14 710078

·A IJ.ilell tU.1dtuo.tml lnfonnatlcn if ii EtlOSl!i - ~ i!i..,,;--,erWeal Cc!~- Date Signed C-57 License Number DWR 188 REV 1/200Cl IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSEGUTI\IEL Y NUMBERED FORM

'The free Adobe Reader may be used to view and complete this form. However, software must be purchased to complete, save, and reuse a saved form . File Original with DWR Stale of California DV\IR Ute Qiil - Do Not Fm In

Well Completion Report Page 1 of 4 Rcfarro lMtivcflOff PeJ1l!l/tld

Owner's-Well Number EW-6A No. e022615S Dale Work Began 05/12/2014 Date Work Ended _.5/""1..,5""/2..,0._.1 ... 4 ___ _ Loca1 Perm t Agency Santa Clara vanev Water pjstrjct

State WIili Number/Sil1t Numbtlr ,-----,-I -1 ..... l~""'-'-r-1 N---,1 l I I l J Lntltude La?ilude

Jw l I I I I I Perm,t Number Pi!rmit Dale APNfTRSIOther

GeoloQic Loa Well Owner Orientation ®Vertical OHorizontal O .Angle Specify Name The Homax ~ rgu12 Onmno Method Hollow Stem Auiior Oiillln~ Fluid

Mailing Address 1835 Barkley Btvd., Suite 101 Depth from S!-lrface Description Feel to F'l!III Oescnbe ma!erlaJ. al1!In Size 0010r oto Citv Bellin9hsim Stale ~ lo 2~226

0 5 concrete Cap Well Location 5 20 Portland Cement/Premium Gel Address 1 ZJQ VIiia ~lrru:;1

City MQYDlaia VieYli'. county San1a Clara

Latitude N Longitude ____ _,yv ~~"'"sec.""" Dea. Min See.

Datum Dec. Lat Dec. Long. APN Book 154 Page 02 Parcel 001 Towt1shlp Range Sea.Ion

Location Sketch Actlvltv ISlu11ch mtiSI tlo dr.t,,n l>V 11.11,_, dGI lonn Is orinlncU ONewWell NCl!lh 0 ModiffcalionJRepalr

OD~pen O0ther

® Destroy Ooscnbe proccdurn and maleriab unde, 'GEOLOGIC LOG"


".I □Domestic □Public

~ I D Irrigation D Industrial

0 Cathodic Protection 0 Dewatering 0 Heal Exchange 0 Injection ® Monitoring

-

0 Remediation 0 Sparging

So1.1lh 0 Test Well

l~hhlo,4rRtlbtcllJUit1t,t;•IMl•00-11u•ih,~ li:n;:ct. 0 Vapor Extraction

r?i'to, ti t i11nd1.0t.Cha,...,_p CJ1♦ 1~fli&Pl!lf.tt\4'-'1Alrf 0 Other ,-_.. M.ac.cuM!t ..... ,C"Ollut\1111&

Water Leif el and Yield of Completed Wen Depth to first water (Feet below surface) Depth to Static Water Le11el (Feet) Date Measured

Total Deplh ofBorfng 20 Feet Estimated Yield • (GPM) Test Type

Total Depth of Completed Well 20 Feet Test Length (Hours) Total Drawdown ___ (Feel) ·May nol be represenlat111e of a wews·1orm term Yleld.

Casings Annular Material Depth from Borehole Type Material Wall Outside Scrun Slot Slze Oopth from Surface Diameter Thickness Diameter Type If Any Surface FIii Description Feel 10 Feet (lnchoiJ (lticheil <rnc~) llnohes\ Foct to Fe.el

Attachments Certification Statement 0 Geologic Log 1. the undersigned. certl~ Chai this report ls conlplele and accurate to lhe bast of my knowledge and belle! D Well Construction Diagram -Name Woodward 0dl Ing Co, Inc □ Geophysical Log(s) PO<llO<l. •<fffl « Corpo~IJoll'

-§~Q Biver BQad Rio Vis!!! _Qi,_ 94:J:!Zl D Soil/Water Chemical Analyses 11~. ~dlV" )_J. / CHv St!lll l,p IZ1 Other Permit Signed A., .,~ ,:;· J, .1 A. 817/14 710078

,\\lru:(I ado11lona1 ,ivormoiion ~ ,t exists C.57 UC0fl1.:l'G Wolai \Nell Ccmtmcjor Dale Skirted C•57 license NUmller r:wvR 188 REV 1/2006 IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM

'The free Adobe Reader may be used lo view and complete lhis !Orm. However, software musl be purchased to cornplete, save, and reuse a saved form. Flle Original with DWR State of California DWR Use On! - Do Nol Fill In

Well Completion Report Page 1 of 4 'ft!ler t0 /11$1,Yct'llll P,1mphlet Owner's Well Number EW-7 No. e0226164 Date Work Began 85f1ele61i4 t2l:•l""P( Date Work Ended ..,5.._l1._.5=/2~0_1_4 ___ _ Local Permit Agency Santa CJara VaUey water Djstrict

~--.---S'rlll ... to""' . .... W..,o.._ll ""'Numbef/Site Number I j l IN I I I I I Latllud II lor.gltude

)w)

I I I I I I L I Permit Number 14000366 Permit Date 511/14 APNffRS/01her -

Geoloalc Log Well Owner Orientation ®Vertical OHorizontal OAn.gle SJlecify Name The Homa~ G(OUQ Dnllmg Method Hollow Slum A11oar Drilling Fluid

Mailing Addre~ 1 ~35 Barkley Blvd., Suile 101 Depth from Surfaee Dtsc;t1pUon CIIY Bellingham State ~ip 98226 Feel 10 Fiiat O_esCl]blt rm1telial 11rain i;iza. oolor e!o

0 5 Concrete Cap Well Location 5 64 Portland Cemen_t/Pr~m!um Gel Address N~( 17 :l 0 Villi ~tmet

City Mouolain Vie.!6: county Santa Ctara

Latitude N longitude ____ _J-J ~ ~ sec:- Dea. Min Sac

Datum Dec. Lal. Dec. Long. APN Book 154 Page 04 Parcel 27 Townsr,lo Ranoe Section

Location Sketch Actlvltv /Slt0!<:11 "'"" be on,.,n bv NOO Illar tonn Is lllin rOd.l 0 New Well Nonh 0 ModifiMlion/Repair

0 Deepen 0 Other

® Destroy Oncrlbe proc~~r. Md male.lials undit,' "'GEOl.OGIC LOG'

Planned Uses 0 Water Supply □Domestic □Public ;;; i □Irrigation □ Industrial ~ w

0 Cathodic Protection 0 0ewatering 0 Heat Exchange 0 Injection ® Monitoring 0 Remediation 0 Sparging

So1.11h 0 Test Well

~.s1udaKribe dnf&l'IC'•ot""°llarffl,,qodt.~ rtv,. J~ , 0 Vapor Extraction fr,tl'I.,. etc:. and ~Hach• m111t, U\4 ~i\1\1 ~~ 'ttr't.ctuar,. 0 Other Pl&n•.0.._1111,ccunt.ancl a;-..,._ water Level and Yield of Comoleted Well Depth lo first waler (Feet below surface) Depth to Static Water Level (Feet) Date Measured

Total Depth of Boring 64 Feel Estimated Yield • (GPM) Test Type Total Depth of Completed Well 64 Feet

Test Length (Hours) Total Drawdown ___ (Feet) ·Mav not be reoresentative or a well's 10011 term viefd.

Casings Annular Material Doplfl from Botcholo Type Maturial Wall Ollteldo Saroon Slot Sito Depth from Surface Diameter Thlckneas Diameter Typa if Any Surface Fill Oescrlptiori Fl!et \o fe11I ,(lnc:hesl !!nch"esl (lnc:ilosl llm;hosl Feel 10 Feet

Attachments Certification Statement 0 Geologic Log I, the Unde1~:r~d. cer!l~ that this report Is complete and accurate to the best of my.knowledge a11d betlef D Well Construction Diagram Name Wg Ws!C:£! Qril ing Co. Inc D Geophysical Log(s) 550 l:1lv:,.eR~a':f~ orColpo,-oJIQl'I

Rio Vis!a Ca 945Zl D Soil/Water Chemical Analyses Signed m..,l/~e_ ~L~/.,... .../

Cily Siale Zip [Z] Other Permit 8/7114 710078

Allau> • "'•Oo1'!111 onformnllort 1111 O>J!ll: C-57 llce!IM!:il WJl\e, Wult corumcra, Dale Sianed C-57 License Number DWR 188 REV 112006 IF ADDITIONAL SPACE IS NEEOEO, USE NEXT CONSECUTIVELY NUMBERED FORM

"The free Adobe Reader may be used to view and complete this form However, software must be purchased to complete, save, and reuse a saved form . File Original with DWR State of California oWR Usa 0nl .- Oo Not Fill ln Page 1 of 4 Well Completion Report I 1 1 1 I

Reier to lnotlUCliOII P~mphfet Sltllc Wlill Number/Sl111 Nu.m.i:,er Owner's Well Number P-1 No. e0226166 1

I IN I G____i I I I !WI Date Wor1< Began fflw12Jii!9~4 ~-\3,l~ Date Work Ended 5/1512014 Lautude ~LD__._na~it~ud_,.eL..-J"--L---1

Local Permit Agency Santa Clara VaUev Water Dlstnct I I I , , 1 L 1 Permit Number 14000355 Permit Date 4/29/14 APNfTRSIOlher Geoloalc Log Well Owner

Orientation ® Vertical O Horizontal 0Angle Specify ___ -1 Name The Homax Group Orillmo Method HOiiow StemAUllfll Drilling Fluid Mailing Address 1835 Berkley Blvd., Suite 10~ Oopth from Surface Dascriptlon

Fee\ ta Feet OOSCtl'be material, aralll sil:o. COlof, ell: 0 5 concrete ~r:i 5 43 Portland Cement/Premium Gel

.Cily Bellingham Stale ~ IP 98226 Well Location

Address N.ear 1710 VIiia Street City Mouotain View County Santa Clara Latitude N Longitude ______ ____::;v ~ --;;;;;;- Soc.""" D9Q Min. Sec

Datum ____ Dec. Lat. _____ _ Dec. Long. ______ 1

APN Book 154 Page _.04=.., __ _ Parcel _1_3 ______ _

Townshlo Ranae Section Loeatlon Sketch AcUvltv

1--oa1Sk_o_tch __ f!10.l:;;;5a;.l.:;.l>l>:...;d;;a; _ __,,;,,_,11•...:11Md=:.aalt=or_!Ol!n;;.;;.;.is;;;.'= Dtl,n.:alel(J. .. Ll"'"-41 0 New Well 1--- ---t-------+-------- ------ -------1 Nonh O Modification/Repair

.; .. w

0 Deepen O Other ____ _

® Destroy Dna\bl! proi:Hufes end malenala umkt '13eOLOOIC lOG'


D Domestic D Public D Irrigation D Industrial

0 Cathodic Protection 0 Dewatering 0 Heat E>1change 0 ltljeclion ® Monitoring 0 Remediation 0 Sparging 0 Test Well SOUlh 1-----1----- +--- ----------- -------1 1-------== ...... -------11 0 Vapor Extraction rtw••I~ or ~cnt:111 dilrarace ot 'NtM -U!'• fffd:..bWkt,11'1(1', r~ 111.,.., ,a. """•"'<h • map. 1.11 • ,jdil,unoi p,ncr ~~oc .. ..,_, 0 Other Pko• bll a11cwllM'anil ~~

Water Level and Yield of Completed Well Depth to first water _________ (Feet below surface) Depth to Statlc Water Level _____ (Feet) Date Measured _____ _

Total Depth of Boring _4_3 _________ Feet Estimated Yield• ____ (GPM) Test Type _ ______ _ Total Depth of Completed Wen _4_1_._5 ________ Feel

Test Length ______ (Hours) Total Drawdown ___ (Feet) •Mav not be ret>resentatlve of a well's loriii lt;lrm vfel~.

DDS)lh from Surface

Foot to Feel

Boroholo Diameter ( lnoho&l

Type

Attachments 0 Geologfc Log D Well Construction Diagram 0 Geophysical Log(s) D Soil/Waler Chemical Analyses

Cas.lngs Material Wall Outald11

Thickness Diameter Uhcl!ell (Jncll~sl

Scroon Type

Slot Size if Any

(lncrhes)

Depth from Surface

Feet to Feel

Certification Statement

Annular Material

FIii Description

1, the undersigned, certltv thot this report is complete and accurate to the best-of my knowledge and bellef Name Woodward Drilling Co. Inc . ·pen,an, Flrm 111 ~

550 River Road Rio Vista ca _.9..,4.,,57'-'-'-1 _____ • 1 IZI other _P-'e"'r .... m __ i,._t ________ _ 4 MliJBU Cl/!~ $Into Zip

Signed rflA< f,✓ %, A&,.I, ,4a, 8n/14 _7_10""'0 ...... 78 _______ _ '$ Uean.lillM!eiWontt.'i~ Date Sianed C-57 License Number

DWR 188 REV 112006 IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVEL V NUMBERED FOAM

"The free Adobe Reader may be used to view and complete !his form, However, software must be purchased to complete, save, and reuse a saved rorm. File Original wilh DWR State of California OWR Use Onl - Do Nol Filrln

Well Completion Report Page 1 of _4___ Refer IO In~troe1tan.P4,rrph1eI Owner's Well Number -'-P-=2=----------- No. e0226176 Date Wol1< Began -es11~ O,:::•tl•t~ Date Work Ended _.5 .... 11...:5,../2.,_0,._1.._4 ____ _ !W) Local Permit Agency Santa Clara Yaney Water Oistrjct Permit Number 14D00356 Permit Date 4/29/14 APNffflS/Omer

Geologic LOA Well Owner Orientation ®Vertical 0 Horizontal OAngle Specify Name The Hom§!l!: GrOUJ;! Dnlllng Method HolloW•SIJlm Avga, Drilling Fluid

Mailing Address 1835 Barkley Blvd11 Suite 101 Dupth from Surface Dascriptlon Feel lo Feot EhlsCl'Pl' mnterlaJ ora!n &lte. 1,01of tile CIIY Bellingham Stale~iD 98226

0 5 Concrete Cap Well Location 5 43 Portland Cement/Premium Gel Address ~ear 1710 ~Ila Street

City MO!,,!!Jl!i!ill Vlew. county Santa Clam

Latitude N Longitude ____ ._SJ c:ioa"-;;.;;:-~ Dea Min Sec

Datum Dec. Lat. Dec. Long. APN Book 154 Page 04 Parcel 13 Towns~ID Ranae Section

Location Sketch ActMtv !Slrolch mia1 be drawn a, IIOnd 81101 !tinn b niffttad.l O NewWell

NOnll 0 ModiUcalion/Repair 0 Deeper. OOther

® Oeslroy Otui,be- prou«lores and ffl6lt1lal1 undtlr .GEOLOGlC lD:G •


;;; D Domestic D Public

I .. 0 Irrigation □Industrial w 0 Cathodic Protection 0 Dewatering 0 Heal Exchange 0 Injection ® Monitoring 0 Remediation 0 Sparging

Soulh 0 Test Well

lb•• .. O'I d«!Hnbe diatllncc ol wi,I horn R111d1.tiu,ld,ngs, len«.e• , 0 Vapor Extraction

tit,; eta, i,nd .anicfl a rn.tp. Use edditll)fl&I IJ-'pef' If necnaary 0 Other ,w,. u.ac-.w,.a.-,c.6'111Di.....

Water Level and Yield of Comoleted Well Depth to first waler (Feel below surface) Depth to Static Water level (Feet) Date Measured

Total Depth of Boring 43 Feet Estimated Yield • (GPM) Test Type

Total Depth of Completed Well 43 Feet Test Length {Hours) Total Drawdown ___ (Feet) ·Mav not be reoreseritallve of a well's Iona term vield,

Casings Annular Material Depth from Bo,ehoto Typo tutorial Wall Outafde Scroon SlotSl.r.e Depth from Surface OJamotor Thlck11n1 Ol1r:noter Typo 11 Any Surface FIii Description Feel lo Feet /lncitasl ll!ldlosl Clncllesl llrtcltes) Feet 10 Feet

Attai;hments Certification Statement D Geologic Log I. the unders,ned, certlrx that this repo1t Is complete and accurate to the best ol rny knowledge and belief D Well Construction Diagram Name WoQ~s}rd Oril ing Co_ [ni. · ·

P (lfMJM. F1m, llr Cofpcwlllino 0 GeophysiccJI Log(s) si:.n River Rn"d Rio Vu.15! .Ca ~4~11 D Soll/Water Chemical Analyses /? l\allfl5~ J. .i.. JI,_-/ 011 Stutu ~!P IZI Other Permit Signed ''ffu ~~_.... J .. t. , J 817/14 710078 , APIW> "6dJiunnl lnlom,alion ii it e,osls ¢-51 _,........,,. alll:I Wl!IICcin1r.u:1or Date Signed C-57 License Number OWR 188 REV 1/2006 IF A0DITI0~L SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM

•The free Adobe Reader may be used to view and complete this form. However. software must be purchased to complete, save, and reuse a saved form . File Original with DVVR State of California OWR Use 0111 - Do Not Flll In

Well Completion Report Page 1 of _4____ Rerer 10 1n&11Ueflon Pamphlel Owner's Well Number _P_-3__________ No. e0226163 Date Work Began1m112120 I'll 05"·t3•l't Dete Work Ended ... 5:.:..11.:.:5.._/ .. 20,._1,.__4..__ __ _

~, -1 ~-

1- j"_af=o_W...,j_l~-jumir71te

1 Nujb~r !

l.t1Utuda lo!)Qllude !WI

Local Permit Agency Santa Clara YaHev Weter District Permit Number 14000357 Permit Date 4/29/14

Geologic Loa Orientation ®Vertical O Horizontal

Dnllfno Method Hollow S1A11r1 A\lo~r 0opth from Surface

OAngle Drilling Fluid

Description

Sp~IY----1

Feet to Fae( Oescobtl mnlail.it. afillln size, calo~. e!C 0 5 Concrete Cap 5 41 Portland Cement/Premium Gel

APNfTRS/OtJ1e

Well owner Name The Homax Group Mailing Address 1835 Barkley Blvd., Sul te 101 City Bellingham State~lo 98226

Well LocaUon Address Near 171 O VIiia S,reet City Mountain \/j&W county Santa Ciani Latitude N Longitude ____ ____y,J

CleQ Min. Sec. Datum ____ Dec. Lat. _____ _ Dec. 4lng. _____ _ APN Book 154 Page ..,0"'4'----- Parcel _1_.3 ______ _ Townst1ir, Ran11e Section

Location Sketch Activity 1-1,.,,:s.,,kot::.:ch::.::.ffll:.:;d::.l·.::.:llO:.:dnM=.:.ri;;J.;. b'f~;;·a.:.:°""=' ... 1o""m1""b"'=pe1"1=C<1.=-J'--II O New Well 1------t'----+----------------- ---1 North O ModlffcaUon/Repair

r,; .. IJ,J

0 D1repen 0 Other ____ _

® Destroy DHcrib1111 procedutra and m11Tctrlnls under-GEOLOGIC LOG'


D Domestic D Publlc 0 Irrigation D Industrial

0 Cathodic Protection 0 Dewatering 0 Heat Exchange 0 Injection ® Monitoring 0 Remediation 0 Sparging 0 Test Well South 1-----1---------------- - ---------11 1------------------------t• 0 Vapor Extraction ::!:ctcar:.:~~:;:~;:!Z;~O:--~~••· 0 0\her

Total Depth of Boring _4_1---_ _______ Feet

Total Depth of Completed Well 40 Feet

Depth from Surface

Fell.I IQ Feet

Borehole Dlamoter UOG'1e5l

Attachments D Geologic Log D Well Construction Diagram 0 Geophysical Log(s) D Soil/Waler Chemical Analyses

Casings ~torlal

IZI Other _P_,e""rm,._.:.,it,._ _______ _ Allat.11 ruldiit0"'11 WQ<m~\l()f\ of tt fl>JI~

Wall ou1•r1111 Thlcknass Diameter

CIJ\Chesl Uncl1cs)

PloaM'1>e-... en6<0......,

Water Level and Yield of Completed Well Depth to first water _________ (Feet below surface) Depth to Static Water Level ______ (Feet) Date Measured 1

Estimated Yield • ____ (GPM) Test Type _______ _ Test Length ______ (Hours) Total Drawdown ___ (Feel) ·Mav not be reQresenlalive of a weJl's Iona term \lielct

Screen TYIMl

Slot.Size IIAny

(!nQJi11$)

Depth from Surface

Feet lo Feet


Annu111r Material

Fill Description

Ca 94571 siat;;" Zip

710076 C-57 License Number r:tWR 186 RE.V. 1/2006 IF ADDITIONAL SPACE. IS NEEDED, USE NEXT CONSEClfTIVELV NUMBERED FORM

'

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I I I I Refer /o'IIJSIIIJC#O(r Pamphlet Owner's Well Number P-4A No. e0226170 .----.---=s,..ta"'"te~W-'--'-<-eJJ .... N""umberlSlta Number

I I I IN I I I I I !WI Date Work Began-86''12'2e'l♦OS-~jQ•\~ D,1 111 Worl( Ended .,.5,_/1..,5..,/2...,,0w1.c:.4 ___ _ Local Pemiil ~gency Santa Clara VaHey Water District

Lotltucte Lonpitud

Permit Number 14000360 Permit Date 4190/14 APNfTRS/Othl!r

Geologic Log Well OWner Orientation ®Vertical

Orilllno Method Hollow Stam All£11,r 0 Horizontal OAngte Specify ___ _. Name Toe Homax Group

Drilling Fluid

Description Mailing Address 1a35 BBJkley Blvd.. Suite 101 Depth from Surface Feet to feet Oesg)bo ma1erlal, grain slie, color. eto City Bellingham State ~ Ip 98226

0 5 Concrete Cao Well Location 5 36 Portland Cement/Premium Gel Address Near 1710 VUla Street

City Mountaig View County Santa Clara

Latitude oea:-~ sec:-N Longitude ____ __:JV

Dea. Min. Sec. Datum ____ Dec. Lat. _ _ ___ _ Dec. Long. ______ ,

APN Book 154 Page _.0__.4 ___ _ Parcel _,1.a:;3 ____ _

Township Range Section

Location Sketch Acbvltv ISl<0!"1 m~lbodiuwnbvh8nd11ttar roon11 .....,11<1J O New Well ......-- ---t-----;------- - --------- - - - - -1 .,. _______ N_o_rt_h _______

1 O Modificalion/Repalr

QOeepen 0 Other ____ _

® Destroy OaKnbe p1ooe.dUle1 ~nd mat.uia~ undtt "GEO..LCGlC L.0.o~

Pl.anned Uses 0 Waler Supply □Domestic □Publlc 0 lrrlgalion D Industrial

0 Cathodic Protection 0 Dewatering 0 Heat Exchange 0 Injection ® Monitoring 0 Remediation 0 Sparging 0 TeslWell S<!ll lti - - - - +----+-- ------- - --- ---- --1 1--------=---------tl O Vapor Extraction llllstrale l)f dttKlibe !Ntance o1•1 !tOO\,....,., ~ .. fG\~

0v1, .. ._. .,c. andaltach • m1p °"'~""prrllMton1r O Other n-:w be ..ccurvru aru;t CA)mok lo.-

Wator Level and Yield of Comoletod Well Depth to first water _________ (Feet below surface) Depth to Static Water Level ______ (Feet) Date Measured ______ _

Total Depth of Boring _3..;.6 _________ Feet Estimated Yield• ____ (GPM) Test Type _______ _

Total Depth of Completed Well 36 Feet Test Length _____ (Hours) Total DrawdolMl ___ (Feel) "Mav not be reorasentallVe of a weU·s 10,m term Yield.

Depth from Surface

Feel 10 Feet

Borehole Diameter ilncilesl

Type

Attachments D Geologic Log D Well Construction Diagram D Geophysical Log(s) D Soil/Water Chemical Analyses

c,slngs Matertal Wall Outslda

TtdcknH& Diameter Unc:f1es) /lncht:!1)

Scroeo Type

Slot Siu If Any

Un,h!ltl

Depth ffom Su!face

Feet 10 Feet


Annular Material

FIii OescripUon

I, the ul'1der.slgned, ~r11fy lhat this report Is complete and accutate to the bes! of my knoWledge and belle! Name . Woodward l!>ritling Co. Inc P_or,;o~. F,tm or Coii,ar.itn111

J&.. .,.9_4;:c.57::...1.__ ___ _ Staie Zip IZI Other ... P ... :e,.rm ....... i"""t ________ _

sso R~ Rio Vista "'°°~ r~ L / orv Signed f tuf'-de,. ll,, ◄~ 817/14 c'.mini~w•10,we1tCentn1clof Dale Sloned C-57 Uoense Number

710078 Atto:cn .llddl\lonllf 1n(nm,n11on If ti- OJCl lll !l.

O'WR 188 REV 1/2006 IF ADDITIONAL SPACE IS NEEDED. USE NEXT C01lS£CUTlvl!l Y NUMBERED FORM

•The lree Adobe Reader may be used to view and complete this form, However, so1Cwa1e must be purchased to complete. save. and reuse a saved form. File Original with DWR State of California DWR Use Onl - Do Not Fil In Page 1 01 ~4__ Well Completion.Report

- Re/e, lo (~l11JctiM P1mphlot Owner's Well Number ..;.P_-4_8_________ No. e0226168 Date Work Began Qil.~05~ le.{ •t'/ Date Work Ended .,.5:.r...11...,5"""/2.,.0:.:.1,.4 ___ _ Local Permit Agency Santa Clara valley Water Di!jtrjct Permit Number 14000360 Permit Date 4/29/14

Stale Well Number/Srto Number ,-------,-1-t .... ,==-~1 N..,] I , , l i t.atruido ~ilude

I r k 1 1 , ,

lwl

fTRS/Otha/

Geologic Log Well Owner Orientation ®Vertical OHorizontal OAngle Specify Name The Momax Gr.ou12 Orilllnp Method Holl0'1v Stam Auger o,mtng Fluid

Mailing Address 1835 Batklell Blvd., Suite 101 Depth from Surface Description cnv Be111asham State~P 98226 fil!!l co FIN!t Describe m'eteflol, aialn slt,e, colQr. etc

0 5 Concrete Cao Well Location 5 59 Portland Cement/Premium Gel Address Neil[ 17j0 ~fli! ~!r~.t City Moun!IDo View county Santa Clara

Latitude N Longitude ____ __JI "'"'"oe;i."" ~ ~ DeQ. Min Sec

Datum Dec. Lal. Dec. Long. APN Book 154 Page 04 Parcel 13 Townshii'> Ran11e Sadlon

Location Sketch Actlvitv (Sl(Otcl1 IT1Ull~dro,m DY""'10-hlnn hi pnntQO,l O New Well Nartll 0 Modification/Repair

0 Deepen O01her

® Destroy Deatribf: pt6UO\J.1.cs ll'd'ffl.lWh.lt-u.nder "GEOLOGIC LOG•


;;; D Domestic D Public 'iii D Irrigation D Industrial ~ ..

'" 0 Cathodic Protection 0 Dewatering 0 Heat Exchange 0 Injection ® Monitoring 0 Remediation 0 Sparging

South 0 Test Well llkn.ttale Of dHcribe distant-a of wwl fron11itads, bulldlnep, renc" ,

0 Vapor Extraction fNefl, ,re and a'ltllch • ,nap Uu ada«)Otlfll pap« if"neceua,y_ 0 Other ~ka« ...... Dlm.,.......,

Water Levol and Yield of Comofoted Well Depth to first water (Feet below surface) Depth to Static Water Level (Feet) Date Measured

Total Depth of Boring 59 Feet Estimated Yield • (GPM) Test Type Total Depth of Completed Well 56 Feel Test Length (Hours) Total Drawdown ___ (Feet)

·Mav not be representative ol n welt 's Iona term-vleld. Caslnas Annular Material Depth r,om Boroholo Type Material W.atl 0u~ldD Screen S(otSIH Dopth from Surface Diameter Thickna" Dl•mater Type If Any Surface Fill Description Ftnl lo Feat (lni:has.l llnellesl (Inches) uric:,es} F11et lo Feel

Attachments Certmcatlon statement D Geologic Log I. the unde~l~ned, cer1i~ that 111is report Is complete and accurate lo the Desi of my knOW1edge.and befief D Well C_onstructlon Diagram Name W.,. • Drll ina f'.n Inc P""'on, ~""' or COfJ>llllilfon □ Geor>hySlcat t.og(s} 550 River Rnart Rio Vista Ca 94~71 D Soll/Water Chemical Analyses tfL A~JS g'J.,,~ City Slnln Z1p (Z] OIiier PeQJlil Signed ·~ ,6 ...,_ ~ .,. • 8n/14 11ooza A)llldl 'l<ldlllOf\lll ,~I-lion ., I Oxisl& - C-57 Ucen•~ot Wei Co11tnitCol Date Sinned C-57 License Number DWR 188 AEV 1/2006 IF AODITION",L SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM

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Well Completion Report Page 1 of 4 Rtr« lo /N/ructiar, p,1"'PI''«

Owner's Well Number P-4P No. e0226172 Date Work Began .a&/~ 0$'~,ct~IC, Date Work Ended _.5"""/1 .... 512=0,.J,_4 ___ _

Stllte Well Number/Sito Number ,----.-,---r-1---'--'-'-r-l N-,1 1 , 1 I , LaJJl.ude Lcnoilude

lwl Loca.1 Permit Agency Santa Clara V.aUev Water District Permit Number 14000361 Pennlt 0ate 4/30/14 APNrTRS/011') r

Geologic Loi:i Well OWner Orientation ®Vertical OHorizontat OAngte Specify Name Th~ Homax GrouQ Orilllno Method Hollow Stem Aimer OrllllnQ Fluid

Malling Address 1835-!l~rkle~ Blvg., Sulla 101 Depth from Surface Description FlliU i.11 Feet De.scribe ma.tenat. 11111in aize, cokit, etc Citv Bellingham State~iD 9B22§

0 5 Concrete Cao Well Location 5 21 Portland Cement/Premium Gel Address t:l!:.i!( 1Z10 Villi! §jreet

City Mo!r.!□!iia Vjew County _Santa Clara

Latitude ~--;;tr,-~

N Longitude ____ ___y.J Dea. Min. Sec.

Datum Dec. Lat. Dec. Long. APN Book 154 Page 04 Parcel 13 Township Ranae Section

Location Sketch AcUvitv ISkotct, rm,st t,o 11..-..n IIY hancl 11110, f01m ii ll!lnled,) O New Well North 0 ModlhcelionJRepalr

O Deepen QOlher

® Dei;troy On.critie ptondlrn and matertJls under UEOlOGIC LOG"


.; 1jj D Domestic D Public

~ .. D Irrigation □Industrial w 0 Cathodic Protection 0 Dewatering 0 Heat Exchange 0 Injection ® Monitoring 0 Remediation 0 Sparging

Soulh 0 Test Well Jli,'111Ar4 Of dtacntle c11D\611CC Of"wal from 1oacb , blilldln jp, h1n~u .

0 Vapor Exrraction 1~ 11~- ,u"IC, ,1tt.c.h • m■p Use addiflOr);II paper 1fntcei5111fY Cother Pkaw ibe -.C(;Ulda Mid CMnDJittil.

1/Vater Level and Ylefd of Comoleted Well Depth to first water (Feet below surface) Depth to Static Water Level (Feet) Date Measured

Total Depth of Boring 21 Feet Estimated Yield • (GPM) Test Type Total Deplh of Completed Well 21 Feet Test Length (Hours) Total Drawdown ___ (Feet)

·Mav not be reoresenrollve of a welt's Iona term vietd. Casln11s Annular Material Depth from Borehole Typo Material Wall Outside Screen Slot Size Do-pth from Surface Diameter Thickness Diameter Type if Any Surfaca FIii Oescripllon Feet to feel llnchesl Unchesl Clncnesl Cinches) Feat lo Feel

Attachments Certification Statement □ Geologic Log I, lhe und~ed.,certl~ thal this report is complete ancr accurate to the besl of my kn9',Yledge and belief D Well Construction Diagram Name W W!)Id Dril Ing C0. Inc . D Geophysical Log(s) l>cr,oo, Ffrm Qt Ce>tpoNIIIOII

~~Q Blvir RQlli! Rio Vista Ca f!45Z1 D Soil/Water Chemical Analyses ~ ~dd!OSS at City 5111111 Zip 0 other Permit Signed '.IJU..6~-- - ~. ,../4~ - - - . 8n/14 7100•78 I Altoch -nuonal l"foll'lllthOr> 11 i i 0,0$l!l. C0 5.7 UciJJ\$1'f]N~1.1!rWo'1 Clll)lllltlO! Dale Sirioed C-57 License Number DWR 1118 REV 1/2006 IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM

'The free Adobe Reader may be used to view and complete this form. However, software must be purchased lo complete, save, and reuse a saved form FIie Original with DVI/R Stale of California OWR \Jou Onl - Do Not I In Page 1 of _4__ Well Completion Report

Ri:tcr ro ln/ll,&Jt/lofl f',,ml)hlet Owner's Well Number ..;.p_. _5A:..:_ ____ .,..-___ No. e0226178 Dale Work Began :§fi/U!1'2014c,;s:1•::H4 Date Work Ended _5 ___ /1..,5.,..(2=0"-1'""4..._ __ _

.---...--S"Tta_te~w...,e"""n..,Numbl!NSJte Numller I I I !NI I I t I I I

La lit will Ginnltude Local Permit Agencv. Santa Clara Vajtev Water Qjstrict Permit Number 14000362 Permil Date 4/30/14

Geoloalc Loa WellOWner Orientation ®Vertical OHorizonlal OAngle Specify Name Ihe t!O!I!a~ Grou~ Drilling Method Hollow Siem Aun11r 011i1111g Flui!I

Mailing Address ]835 Barkle:t: Blvd,. Suite 101 Depth from Surface OescrtptJon Feet IC Feet Cll$Cnbe matelial ornln~Jze color ate Citv Bellingham Stale~lo 982~§

0 5 Concrete Cao Well Location 5 36 Portland Cement/Premium Gel Address -~~s!' '.lZ]Q Vllla Street

City MQ~IQI!'!![! Vf~ County Santo Clara Latitude N Longitude ______ _:JV

[)eQMi'ii""""sec° Dea Min, Sec. Datum Dec. Lal. Dec. Long. APN Book 154 Page 04 Parcel 1.3 Township Ranae Section

Location Sketch ActMty (SkQli;IJ nllllll bl! dtoWn DY hnnd allot !Mn It citlnlod.) 0 New Well

North 0 Modification/Repair 0 Deepen O0!her

@ Deslroy Dflliaihll p1oe.tdt,1~ ~ m■leftAi" W1der "GEOLOGIC. LOG"

Planned Uses 0 Water Supply □Domestic □ Public .; ;; D Irrigation □ Industrial ~ ..

w 0 Cathodic Protection 0 Dewatering 0 Heal Exchange 0 Injection ® Monitoring 0 Remediation 0 Sparging

SoutH 0 Test Well

tllll~:alc er descnb2 dil.t.nc11 ot •~ i~\\ tU40'l-, ~ 1-.1o«. 0 Vapor Extraction

rwn " , 41&, lffld elbch II map U'I• •ddttiom1I paper If ~·ou,y Q 0lher ....... ba a«1.'ntl Md COffll'll,r'.a

Water Level and Yield of Completed WeJI Depln to first water (Feet below surface) Depth to Static Water Level (Feet} Date Measured

Total Depth of Boring 36 Feel Estimated Yield • (GPM) Test Type Total Depth of Completed Well 36 Feet

Test Length (Hours) Total Drawdown_(Feel) 'Mav not be reorese_ntallve of a well's lonn term vleld ,

Casings Annular Material Depth from Borehole Type Materlal Wall Outside Screen Slot Size DepUI from Surface Diameter Thickness Diameter Type If Any Surfaee Fill Description Feel 10 Feet Cinches\ (Inches! {Inches\ (Inches) Feel la Faul

Attachments Certification Statement 0 Geologic Log I, the undersigned, cert!~ rhal this report ts comple~ and accurate 10 the best of my knowledge and belier D Well Conslruction Diagram Name la{Qodward Ddl ing CQ, l!lC D Geophysical Log(s) P~rlOII. Fi"" o, Corporation

~5Q Bill~[ Road Rio Vista Ca ~§:7l D Soll/Waler Chemical Analyses /b-,u Munm / Cit\' ~ Zip 0 Other Permit s igned~~ t J LJ~J;u,_ 8{7114 710078 1\11..., cddli,o,,aJ w,m,,uuan 11 ,1 ,atlats: C-S7 r - ml Wlllfll'Wnll CMlm,to, Date Slaned c .s,7 License Number DWR 188 REV. 112006 IF ADDITIONAL SPACE IS NEEOED, USE NEXT CONSECUTIVELY NUMBEREO FORM

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File Original with DWR Slate or California DWR I.Joo Onl - Do Not Flll In Well Completion Report

Page 1 of _1'--4'--- Refer 10 lns/rucflon Pamph/el Owner's Well Number .;.P_-.:;.5;;:;.B____ ___ _ No. e0229469

l

Date Wark Began-G5t-121Zctt4 OS~\-t.-i'f Dale Work Ended _.5...,/1,..5.._/2=0,._1..._4.__ __ _ Local Permit Agency Santa Clara Vaney Water District C Permit Number 14D00363 Permit Dat 5/1/14 e

Geoloaic Loa Well Owner Orientation ®Vertical 0 Horizontal OAngle Specify Name The 1-fomax Grou12

Drilling Melhod 11ollow Stem AUoor O(llling f luid Mailing Address 1835,Barktey Blvd, .Sulte 101 Depth from Surfal:1) Doscliiptl~n

Feot ID Fl!tll Doscrlbo malerial nraln $lu! color etc City Bellingham Slale~lb 98226 0 5 Concrete Cao Well Location 5 70 Portland Cement/Premium Gel Address Near 1710 ~ !Ila Street

City MQ!.!□ leJ□ View county Santa Clara

Latitude N Longitude _________ w ~~~ Dea. Min. Soc

Datum Dec. Lat. Dec. Long .

APN Book 154 Page 04 Parcel 013 Township Range Section

Location Sketch Activitv (Skol~ mu!! bo d r.>wn by MIid Mllll !om, ~ DntUod..l 0 New Well

Noilh 0 Modification/Repair 0 Deepen 0 Other

® Destroy DO'M;llbu prowdwas .nru1 rna1cr1al~ Ur,dar 'GEOLOOJC l.OC~


D Domestic D Public ;;;

"' D Irrigation 0 Industrial ~ <IJ uJ

0 Cathodic Protection 0 Dewatering 0 Heal Exchange 0 Injection ® Monitoring 0 Remediation 0 Sparging

Sooth 0 Test Well

IIIU!>Valll Of <k~C11bo d1~l.:mcu (11 WI.Ill (mm .road.s, b\Ji ldU'l{l!t , F1)1lC~t;. , 0 Vapor Extraclion

h1 !CG. t~ ~,,.._. .Jtl.i.lch a m,1p u ,e 11d0,1..onal pa;i(:f" 11 r.oc(lssary_ 0 Other D1t1M b,f,-'C.111.at. 4.n,d Comd .. M

!Water Level and Yield of Completed WeJI Depth lo first water (Feel below surface) Depth to Static Water Level (Feet) Date Measured

Total Depth of Boring Feet Estimated Yield • (GPM) Test Type

Total Depth of Completed Well Feel Test Length (Hours) Total Drawdown ___ (Feet) "May not be reoresentallve of a \val!'s Iona term vield.

Caslnas Annular Material Depth from Borehole

Type Material Wall Outside Screen Slot Size Depth from Sur1ac:e Diameter Thickness Diameter Type If Any Surfaco Fill Description

Feet lo Feet /Inches\ (lnchesl (lnchesl rlnchesl Feel 10 Feel

Attachments Certification Statement D Geologic Log I, the Unders~ ned, certilrr that this report is complete and accurate lo the best of my knowledge and belief D Well Construction Diagram Name WQQ Ws!rd D [ jl !!Jg Co, In!:;

D Geophysical Log(s) Porspn.. Firm or Cqrpo,ul""°

550 River Road Rio Vista CA 94571 D Soil/Water Chemical Analyses Signed { '-1nJ.d!'~ - h ~ { ff- -J~ - /7 B/28/14

Slale Zip 0 Other Permit 710079

A11rml, rtdtl1:t1onttt (nfcumation if il alCJst!:J c-s7 l1ccnscd IVnf,f Wtin~...:\o• Date Signed C-57 License Number DWR 188 REV 112006 IF ADDITIONAL SF>ACE IS , EEOED. USE NEXT CONSECUTIVEL V NUMBERED FORM

•The fre11 Adobe Reader may be used to view and complete this romi. However, 50flware must be purchased to complete, save, and reuse a saved form, File Original with DWR State of California OWR Ui;e Onl - Do Nol FUl In

Well Completion Report Page 1 of _4____ Reier to /nsrruc1;00 Pamphlet OWner's Well Number ""P_·.;;;;5 .... P________ No. e0226174 Date Work Began 85~12'12:0'T4Q.::S-tt'i, 1~ Dale Work Ended ..,,5"--/1'-"5....,/2.,.0 ..... 1~4 ___ _

Stale wen Number/Slte Numbe! .------.- 1-l=-'-1-'-'-rl N'-'-il I 1 1 1 1 1 La i.uda lonBltudc

Local Permit Agency Santa:Ciara Valley water Distrjct Permit Number 14D00364 Penni! Dale 5/1/14 APNffRSIOUlar

Geologic Log Well Owner Orientation ®Verttcal OHorizontal ()Angle Spucify Name The Homax Grau~ On1lrng Melllod Hollow Stem t\uner Drilling Fluid

Mailing Address 1835 Barkley Blvd., Sulte 101 Dopth from Surface Dos1;rlptlon Feel to Feel D&llllril>D .maleri~I a rain size a,lar, BIC Cllv Bellingham Slate~io i~226

0 5 Concrete Cao Wall Location 5 21 Portland Cement/Premium GeJ Address N.§.i!! H:10 Ville Stre!ilt

City Mou!11ain Vjaw County San1a .Clara

Latitude N Longitude ______ ___y,J "o;;;-~ """sec Dea Min Sec.


APN Book 154 Page 04 Parcel 1.3 Townshlo Range Section

Location Sketch Actlvltv ISkottl> mua&lll& dlll\\fl 1W l)Md l!ter ronn Is <IML!ld.) 0 New Well

North 0 Modification/Repair ODeepen Q0lher

® Destroy OG11C11be J>(~dure1 and mal11riab l.lndllf "GEOLOGIC LD<r


;;; □Domestic □Public

I I .z □ Irrigation □ Industrial

0 Cathodic Protection 0 Dewatering 0 Heat Exchange 0 Injection ® Monitoring 0 Remediation 0 Sparging

South 0 Test Well

~•·r oc de,c.otia cfiltance of woW ft'om load~. buildings, lfflc.e&, 0 Vapor Extraction

r,,,tn1 tk- and albc:f11 mep. lhe addititi.nal p,aper II noce-n11ry 0 Other PMIUl•O.-HCWIM.&11d ~ra.i ...

Wator Level and Yield of Completed Well Depth to first water (Feet below surface) Depth to Static Water Level (Feet) Date Measured

Total Depth of Boring 21 Feet Estimated Yield • (GPM) TestType

Total Depth of Completed Well 21 Feet Test Length (Hours) Total Drawdown ___ (Feel) 'May not be reoresenta1ive of a well's Iona tenn vleld.

Casings Annular Material Oopth from Bortiholo Type M;iterlal W~I Outside ·scn,on Slot Site Deplhfrom Surf11en Diameter Thlcknaaa Diameter Type If Any Surface Fill Description Fecl 10 Fe:el llnchlHll Or,ctle$l <lhcli!!SI llnC/1.l!Sl Feet 10 Feet

Attachments Certification Statement D Geologic Log I, the underslsnetT, cerllre 111al thfs report Is comple.le and accurate to the best of my knowledge and belief 0 Wen Construction Diagram Name WQ.2 warQ Dril lag Co. 1nm 0 Geophysical Log(s) _ Pe/Son, Flrrn or~"'°

550 Riv~r Roi!Q · RiQ Vista ~ ~4571 D Soll/Water Chemical Analyses !ldl"Jt NJ4IO!S..,. f._ lt /4,;,,/j City Sllllb ZIP IZI Other Permit Signed A./~~ ........ Sn/14 710078 AWldt t><!dl''""'' 1.1 .... ,., .... ,rl 11 "'111_. c"-61 LIQ)IIW!I W]!JU WIii! C<Jnltilc,lor 0aleSicmed C-57 License Number DWR 188 REV, 1/2006 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM

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State of California

Well Completion Report Page 1 of _1_0___ Refono Jnsu1,otioo Pamphlet Owner's Wall Number _V_-_1__________ No. e0229474 Date Work Began 05/12/2014 Date Work Ended ~5 .. 11 .... 5..,/..,20_1_4 ___ _

File Original with DWR OWR Use Gnl - Oa Nol F..:;ll"-'11,.__ ____ -i

I ~~ [-=,,.-..-:c-s1ale wen Nu.ml>er/Slle Nu"nil:l= cr=----~

C I 'rl--'-...,.,..-~ ~ I~· . ...J ~ t,a1i. o __ .00111tuclu

Local Permit Agency Santa Clara Va)(ey Water Distdct Permit Number 13000564 Permit Date 12/12/13

J_~....,• = ==,,.,,..---APNITRS/0lhor

Geol09Tc LOQ WellOWner Orientation ®Vertical 0 Horizontal OAngle Specify Name The Homax Grou12

Dnlll"9 Method Hollow Siem Alll)Ur Onlhog Fluid Mailing Address 1835 Barkley Blvd., Suite 101 Depth from Surface Doscrlptlon

Fe'!!t to Foot De$CnDO mo1ertal.-0raln size cOlcr, Ille Cllv Bellingham State~fp 98226 0 5 Concrete Cao Well Location 5 50 Portland Cement/Premium Gel Address Near 171Q Villa Street

City Mountain View County Santa Clara

latitude N longitude _________ w "o"en~~ ODQ. Min . Sec

Datum Dec. lat. Dec. Long.

APN Book 154 Page 04 Parcel 013 Township Range section

Location Sketch Activity (Slutldt rt1U11l be drawn by hilnd JIIU!r flllll\ 1$ pnnlocU 0 New Well

Norlh 0 Modification/Repair 0 Deepen 0 other

® Destroy Oc:Jsu1be proceo.,,o., .and m.ilarials und~ "'GeOLOG.IC.LOG-


O Domestic D Public in in D Irrigation □Industrial ., .,, ~ w

0 Cathodic Protection 0 0ewatering 0 Heat Exchange 0 Injection ® Monitoring 0 Remediation 0 Sparging

Sot.llh 0 Test Well

IIIU!ilrate- or 0ttsr.r,oo d1l>t.1nu.> cl ._,.,oil from rO.Jds t:u.11lrl.if19:j, ror1ool'.I 0 Vapor Extraction

thmr~. Ole. um.I uh.id, a map Usa addiU0011I ~1PN ,f 11(JC1Jnary 0 Other ,~i.~u tMl 1Cttit'>1taa ,;d comolll&

vvater Level and Yield of Completed Well Depth to first water (Feet below surface) Depth to Static Water level (Feet) Date Measured

Total Depth of Boring Feet Estimated Yield • (GPM) Test Type

Total Depth of Completed Well Test Length (Hours) Total Drawdown ___ (Feel) Feet •Mal/ nol be represenlelivl;.l of a wall's loOA term vleld.

Ca!!ings Annular Material Depth from Borehole Typo Material Wall OulsldE! Screen Slot SiZEI 0epth from

Surface Diameter Thickness 0lamotcr Type if Any Surf~ce Fill Description Feel 10 Feel finches I (lnchesl ilnchesl /Inches) Feet lo Feet

Attachments Certlflcatl~n Statement D Geologic Log I, the. und:;_,'!7~:!,ed, cert\~ that this repotl Is complete ar,d accurate to the best of my knowledge and belief D Wall Construction Diagram Name W • ·,,,.,d Drll ino .Co Inc

Person, Firm or Corporalion D Geophysical Log(s) 550 RRIP( Road B io Vista CA 94571 D Soll/Water Chemical Analyses .~ 1111a,~i &. /.1,,L.- c-1 - r,y 8/28/14 Slate Zip

0 0lher Permit Signe . ,~.,~- - 710079 .J\tlDct• 11ddd,unnt u,ft:m"t8tton II 11 n,o~lfl. CS1 L.,.n""'11'1t"' Wcff Conlrncror Date Sinned C-57 License Numbef DWR 188 REV \/2006 -IF IIOOITIONAL SPACE IS NEEDEP, USE NEXT CONSECUTIVEL V NUMBERED FORM

'The rree Adobe Reader may be used to view and complete this lorm. However, software must be purchased lo CQmplete, save, and reuse a saved form, File Original with 01/1/R Slate of California DWR Use Ohl - Do Nol FUI In Page 1 of 4 Well Compl~tion Report

Reier to lnstrualon Pamphlet Owner's Well Number V-4 No. e0226146 Date Work Began .OS~e'M- Q!l'·\.S.~19 Date Work Ended _5-/1...,5,../2~0~1~4 ___ _ Local Permit Agency Santa Clara Valley Water Djstrjct

I I . I I I I Stal Weh Numbe1/Sile Number

r---r-, ....,j~-'----r-1 N--;I I , I , LoUtuae 1.a7i1udo

Permit Number Permit Date APNITRS/Othor

Geoloalc Ltw:1 Well Owner Orientation ®Vertical 0 Ho1r.:~m1a1 OAngte Specify Name The Hom5!1;1 G(OUE! Otilllng Method Hollow Stam Auger oru11ng Fluid

Malling Address 1835 Barkley Blvd .• Suite 101 Depth frotn Surface Description Fool to Feot Oesctlbe malerlJl, orain size, (;Olor ell) cuv Belli!lgham Slale~lil 98226

0 5 Concrete Cao Well Lo~tion 5 40 Portland CemenUPremlum Gel Address 1710 Villa ~t

City MOU!lli!in )Li~~ county Santa Cl,ira Latitude N Longitude ____ ~ ~~sec:- Dao Min Sec Datum Dec. Lat. Oec. Long. APN Book 154 Page 02 Parcel 001 Townshfp Ranr:ie Section

Location Sketch Actlvltv ISl!ou:11 mutt bo <1mwn by hsocl lllter10ffl1 It mn!Od.) Q New Well

Noni\ 0 Modification/Repair 0 Deepen 0 Other

® Destroy O~ritlD proc;et1ure.1 •nd malc!Tt ■I• iJndar •GEOLOGIC LOG"


1a □Domestic □Public

I ., □Irrigation Otndustrial w 0 Cathodic Protection 0 Dewatering 0 Heat Exchange 0 Injection ® Monitoring 0 Remediation 0 Sparging

SuLdh 0 Test Well

IJ!l'111Al<"'-·•"" tC'oJ ~ hm Jo.tdt ... ~n.p,.!dltit't t 0 Vapor Extraction IMlrt.,,tlC, a\dAtLu fla m19 ·°" ~ff'IVftlMCnM'}'. 0 Other P.....,_ M act-11- - .n.d t~f41 '

water Level and Yield of Com0leted Well Depth to first water (Feet below surface) Depth to Static Water level (Feel) Date Measured

Total Depth of Boring 40 Feet Estimated Yield • (GPM) Test Type Total Depth of Completed Well 35 Feet Test Length (Hours) Total Drawdown ___ (Feet)

•May ootbe representarive of a well's Iona lr!:rrn Vield. Casings Annular Material ou-pth (rom Borehole Type Malarial Wall Out:,ld11 Screen Slot S1io Depth from Surface Diameter Thlcknasa Diameter Typa If Any Surface FIii Description Feel to Feill llnchosl (Inches) llneliusl (lntlh~l Feet 10 Feet

Attachments Certlflcatlon Statemant 0 Geologic Log I, the ui,dersf11ned, i~~!at this report Is complete and accurate to lhe best of my.know!edge and bellef 0 Well Construction 0iegrem Name ._. , -rd . . Co. Inc Pe(>()/\. Flml a, CQlpOfflllcn □ Geopt\y1>f~l Log(s) §~Q Ri~r BQs!d Rio Vfsls! Ca 94571 D Soll/Waler Cl1emtea1 Analyses I "'!Ulm .. C,ty Stale Zip 0 Other Permit Sfgned '/'Yb~., _ .t; /i/,.-1:o. h ~,/ 8/7/14 710078

AUN:n llc/i!•••Olll>I rr,/orm~II"" d II OlOStl<: "t; ,!',7 ll~f\$jCI Wl\lcr wou Conllattor -Date Slaned C-57 Ucense Number 0/VR 188 REV 1/2006 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM

·the rree Adobe Reader may be used to view and complete this form. However. software must be purchased to complete, save, and reuse a saved form. File Original with DWR State of Calilomia _ ______ 0,.._)W"""-'IR..=U;.:,;se:.O:.nlv- 0o Nol Fin In

Well Completion Report Page 1 of .... 1_3___ R•f•r lo lnslruCliCJfl Pamphlet ~ - . l ' 2-1.......i , _ Slate WefJ Nu"lbor/SJIB Nu~.,be;.:..t __ _ Owner's Well Number ...;V_-=5------,- --- No. e0229481 Date Work Began ~ ·1212mar1>, 1Cf Date Work Ended _.5.._/...,15.,.l.:.2,._0-"14;e._ __ _

l-1 1 · Tu ~] I _ w, loH1u au l!)flifl!!!d::.:O:,._ __

Local Permit Agency Santa Ciera YaUey Weter pjsuict Permit Number 14000353 Permit Date 4129/14

0 5

Orientation ® Vertical Dlllllflg Method ,~oUbw ·Stem AU!lll!

Depth from Surface Feet to Feel

Geologic Log 0 HorizonleJ OAngfe Spodfy_· _ __ ,

Orjlllng Fluid

Description D1itcrlb·e mntorial._ 1ualn site a,lor eJe

5 Concrete ·Cao 41 Portland CemenVPremlum Gel

~- l-- _ I I A'""P,-!,N:-::ITR=s'"",o:,17ehtlr

Well Owner Name The Homax Group

Mailing Address 1835 Barkley Blvd., Svlte 101 cuv Bellingham State ~ Ip 98226

Well Location Address Near 1710 Villa Street City Mountain View county Santa Clara

Latitude N Longitude ________ w De<!, Min . Sec.

Datum ____ Dec. Lal _____ _ Dec. Long. _ _ ___ _

APN Book 154 Page _,0 __ 4~--- Parcel ..:0;..:1..a:3 ..... _ __ _

TownstilP Range Section

Location Sketch Activltv ~.i::IS::ek"e::'":.:.:h;,::mua= ' .=ll<>::.;<1:::;ra::.;wn::.:.::b.,;vlln=nd:.:~='"'·rann= •,::. ls1= """::::lftlL=-"'--11 1 Q New Well 1----+-----+--------------------f N011h O Modification/Repair

Total Depth of Boring Feet ---------- -Total Depth of Completed Well __________ Feel

Doptt,lrom Surface

Feet lO Feel

Borohole 01:,rnctor flm;tie~)

Type

Attachments

Casings

Material Woll O.utsldo Thickness Diameter

tlncl:ips) lh'lf.hos.)

0 Deepen 0 Olher ____ _

® Destroy Oei;.cn r111 oroc.cuturos and m.1teNtls undor ·oEOLOGIC LOG"

Planned Uses 0 Water Supply □Domestic □ Public D Irrigation D Industrial

0 Cathodic Protection 0 Dewatering 0 Heal E,cchange 0 Injection ® Monitoring 0 Remediation 0 Sparging 0 Test Well Sgulh

l-11-,u.s-,.-,.-.-, d--- ,bo-d-~,-.,,-..,-.,-,.-~,--11,--am-,,,.- .. -. '"-.,1c1- ,'"- ,,-.. ,-.,.,-,.-,.-ti O Vapor Eictraction n~en;, etc, M4.1ll.'.1chamap Useadi:t,t<lf\o1lpoc,etdrn1eossary Q Other Ple••• 'b• fH:CcU ti.t, ■Ni c:ompt.110

!Water Level and Yield of Completed Well Depth to first water _ ________ (Feet below surface) Depth to Static Waterlevel _ _ ____ (Feel) DateMeasured _______ , Estimated Yield ' ____ (GPM) Test Type _________ , Test Lenglh _ _ _ ___ (Hours) Total Drawdown ___ (Feet) ·Mav not be represenratlve or a well's loog tenn yield.

Screen Type

Slot Slza if Any

l lnchos)

Depth from Surface

Feel lo Feet

CertlflcaUon Statement

Annular Material

Fill Description

D Geologic Log D Well Construction Diagram D Geophysical Log(s)

I, the undersigned. 1:er1tr~ thal this repor1 Is complete and accurate to the best of my knO\vledge a11d belief Name Woodward Drilling Co. Inc:

D So I/Water Chemlcal Analyses 0 Otller .._P..:.e::.:.r.:..:m"-'-lt'---------

Adl1e11 ndftl l10Mal inrormalion ir il exists

□WR 188 REV 112001,

Pb,.Joo .. F11m orCorporalion 550 Rivar Road

{ f /r\,. Addleos S gned AJ I( J' ~- •

Rio Vista !,,- / J JI Cily ~c.n • 1 l r. - ~a,.14

Date Sinned IF AOOITION,\l SPACE IS NEEOED. USE NEXT CONSECUTIVELY NUMBERED FORM

CA 94571 Slalo Z,p

710079 C-57 License Number

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- Refet lo liulrur:110'1 Pimphtet Owner's Well Number -'V'--.;a.6_________ No. e0226180 · Date Work Began DefH!./281-4 O!f~ I Cf· 19 Date Work Ended _.5.,_/1..,5,,.,/2""0"'1""4 ___ _ Local Permit Agency Santa Clara vaney Water pjstrjct Permit Number 14000354 Permit Date 4/29114

,----,---'is~ta'-le'-W---..ei ... l N;.;umber/Slte Number I I t ! I l Nl I I I Lallludo Longitude

)Wl

I I ~ I I I fTRSIOl!H,r

Geologic Log Well Owner Orientation ®Vertical OHorizontal OAng~ Specify Name Th~ Homax G[OU(! On11ing Method Hollow Stem AUgcT Drilling Fluid

Mailing Address 1835 Barktev Blvd. Suite 101 Depth from Surface De,crlptlon Feel LO Feel OctGcribe m111et1ll 11rulo-slto. color. etc Cltv Bellingham Stale~lo 98226

0 5 Concrete Cao Well LocatJon 5 48 Portland CemenUPremium Gel Address NE 1§Qi t!lgggn ~i&. NE ~i~~ g[ milr~s;! iracks City Moun!s!ICl View county Santa Clara Latitude N Longitude ____ __J,/ ~----;;-~ DeQ. Min. Sec. Datum Dec-Lat. Dec. Long. APN Book 154 J;>age 02 Parcel 054 iovmshfP Range Section

Location Sketch Ac:tivltv IS!<etcll must be Ml1i!l l)y tiana 1111.•~ lonn il Mn(Ud.l O NewWell

Nortll 0 Modifillilllon/Repair ooe·epen O 0tl\er

® 0estray Deacribe prourJuras and m•lwab w,det "GEOl.OGIC: LOG•


ui □Domestic □ Public ui D Irrigation O Industrial ~ ..

w 0 Cathodic Protection 0 □ewatering 0 Heat Exchange 0 Injection ® Monitoring 0 Remediation 0 Sparging

South 0 Test Well

lti, a'if• or ff~ickfll\Ce or,wet •cun•i>l41....~. ltt!io. 0 Vapor Extraction lh~. r \Lllftdaft»cttamo.a.· lh,.e.ddlfi~p.-,,lf .t~ 0 Other """"'• be.a«li,(9t•and ._-W.

Water Level and Yield of Completed Well Depth lo first water (Feet below surface) Depth to Static Water Level (Feet) Dale Measured

Total Depth of Boring 47.5 Feel Estimated Yield • (GPM) TeslType Total Depth of Completed Well 42. 7 Feel Test Length (Hours) Total Drawdown ___ (Feet)

'Mav not be representative or a well's long l<!fTTI yield. Caaings Annular Material Depth rrom Borehole

Type Material Wall Outside Screen Slot Size Depth from Surface Dt1mater Thickness Diameter Type If Any Surface FIii DeseripUon Feet lo Fe.el Onches) Cinches) !Inches) (lnche$) Feel to fool

Attac:hments Certification Statement □ Geologic Log I, the undll(Sl,jned. certl~ tt,al this report Is complete and accurate ta the best or my,knowteage ancl belief D Well Conslrucllon Diagram Name ~Qg warg Qril ing QQ In!.

Person, Fllffl orCo(J>oratlo/l D Geophysical Log(s) 51,n Rive(Rn,,,.1 Bia Vists Ca 94571 D Soll/Water Chemical Analyses In,,., A,dcltess y h~ J>.A.d City Slllio Zlp @ Other PermlL Signed A_j-:,_ 8f7/14 710078 A1rne11.:idQ1Uom11 tnlq,mnt,on a~ Qxlsts. C-!P Ucon>e<I JIY"Tor Wei Coro!ft!tto, Dale Sinned C-57 License Number DWR 188 REV. 112006 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM

_ • rhe tree Adobe Reader may be used to view and complete this form. However, software must be purchased 10 complete, save, and reuse a savetl fonn . File Original with DWR Slate of California DWR Use Onl - OifNol m In \ 1 Well Completion Report ~:r's Well Num:..,.. _____ _..:;V __ -_']__.___ !:.',~~~~:;~h~r Date Work Began '.'\f uli➔ Date Work Ende(! _4:~t.r~if+-/4..._ ___ _ Local Permit Agency~.,,.S __ C-"'"V'-="&...__..t) _______ ..,,.. _ _ ________ _ Permit Number 'lY.DtJ7c,'>&J$, Permit Date 6 - / ~ - l'-i

Stoic won NumbortSllc Numt~, I,....--.-,-, -c;lr---=-1---'-rlN~I I r I I I , jw] Lamu<1a Longl1uda

I I I I I J I I j I I J APNFTRS/Olho1

Geoloalc Loa Well Owner Odentallon JPVertloal OHorizontal OAngle · SpecJfy Name -.iu. Ii.-..- ~ l--:>c-D.

Drilling Miilhod Drilling Fluid Mallll~Address ,n ,;· ~ .LI,, ~JJ ,.~1@, tol Depth from Surface D11ser!ptlon C1tv J\ ·~ 1- ~ 1 Slate/,.,.') A "7I- "R?,,. "U. feel lo Feel Ouscr,oo 111a1arinI, oraln alzc1. co\Qt u1<>

0 ~ r,_ . - 1 . r ... ..... Well Location ~ '\+ ~ ... ~ ' ~ .\ r .. - .. -+ f'fr'n.- • -· ~ Address t'lt_d.~c-- 'j _, ~ .l .. rC..,.{,_\ -ho. - -- · ~ ~ lJ~,rl-' l"HD

I City lt:l,a.~-\:..:.,..~it~,(~ Coul'lt'(• ,I._ (4, ,~ v.-n .. ->T•

Latitude N Longitude ____ ____yJ l)eQ~Sec Ooo. Min. See.

Datum Dec. Lat. Dec. Long. APNBook ! SY: Page 0"1...-- Parcel fJA Township Rnnne Seclion

LocaUon Sketch Activity (Sl<~ld1 ITl.lSt b!I dlalM! by hlllld ah., fllll!l ls PMIO<l,I 0 New Well Nonh 0 Modification/Repair

0 Deepen 0 Other

~ Destroy o-ai.tio o,ooed11ra and ff\M9Nla int• ~GEOI.OGtC Loo·

Planned Uses 0 Water Supply □ Domestic O Public 1n ! D lrrigallon D Industrial 3

0 Cathodic Protection 0 Oewatering 0 Heat Exchange 0 Injection e Monitoring 0 Remediation 0 Sparging

South 0 Tes!Well

ltu...-.• ora.cnbalist&nal OI .... ~~•. buldlf,gis~tar'lm5, 0 Vapor Extraction

~' 11111r:. ■Ad..u.d'l ■ f11W. U..M~,-pa,lllllle"M1MV 0 Other .,.,_1,o....,...,..,.;_,._ Water Level and Yield of Comolated Well Depth to flrsl water (Feet below surface) Depth to Static Water Level (Feet) Date Measured

Total Depth of Boring L\'.2-•.S Feet Estimated Yleld • (GPM) Test Type Tolal Depth of Completed Well ''3~·' ~tA.1:(LA Feet

Test Length (Hours) Total Drawdown ___ (Feet) 'Mav not be reoresentaUve or a w1:1n's.lonQ lerm Y1ete1 .

Casings Annular Material D1ipthftOIYI 80,-.holo Type Matula! WIii Oulllclt Screen Slot Size Dtplh from Surbco Diameter Thicknaas Diameter Typo i,Any Sumu:o Fill Description Feel lo FCOI llflcho&l (lnOhe,;l nnchnsl nnc11es1 Foal ~ Fool

Attachments Certlficatioo Statement D Geologic Log I, the u'fl~~jrllf~l 'f;~~~ If~ and ~ccy,te lo l~~st of my knowledge and bellef 0 Well Construction Diagram Name I • • • £'\r '-. 1<' □ Geophyslcal Log(s) H5C. ~·~r7Jf :"o--"'Ft?br"}-r/ fc(_,n 11/,~. s;A._ qt.pS7L D Soil/Water Chemical Analyses A~ .. ~f/61 ~ .. h 1.~ ,,, . -- .,,,# City i V1.t11! I Ys

'111tlCi..l 1.li □ Other Signed

I All""" ,.w1•-,1 ,•,,_,atlan ~ it exists. C-57\.l!:tOi,,iJW/lU!tWIIIICclltroe.tor Da e Sianed C-57 License Number -OWR 188 REV. 1/2000 IF "°DITIOIW.SPACE IS NEEDEO, USE NEXT CONSECUTIVELY NUMBER.EC FORM

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Well Completion Report Page 1 of 4 Refer to lnslroct/OIJ Pamph/81 --~--=S;.;;lll:;,:;14=-We"-'-i';.:.n ._Nu(nbl!f/Sita Numb11r Owner's Well Number V-8 No. e0226141 I I I I l NI I I I I l )wl Date Work Began 6!tf12i2944 ~- II-IL\ Date Work Ended §,l16{i!Q_14 C8, 12 ·1'/

Local Permit Agency Santa Ciara YaUey water District l.:atitudo Longitude

APNfTRS/OIIM!r Permit Number Permit Date

Geolo9lc Loa Well Owner Orientation ®Vertical 0 Horizontal O Angle SpecWy Name The Homax Groll!:! Drilling Method .Hollow Stem Auger Drilling Fluid

Mailing Address 1835 Bari<ley Bjvd., Suite 101 Depth from Surface Description Foot lo f Mt D;;acnbe m11ar1111 A rain aiztt, C(')lor. otc Clly Bell ingha[!! Stale ~lo 982.26

0 5 Concreta Cao Well Location 5 49 Portland C_ement/Premium Gel Address NI; sl!e of Qel)tfi!l 0<1:1r!l~W~ll, Nf;.orlZjO VIila §t

City Mount&ii!l View County Santa Clara

Latitude N Longitude ____ --fl 7ie;;""" ~ ~ Deo Min Sec

Datum Dec. Lal. Dec. Long, APN Book 154 Page 02 Parcel NA TOWAShlP RallQe Section

location Sketch Activitv ISltltdi mu1111$,drawn tw hand an~ lonn " mnroa I O New Well NO/Ul 0 Modificallon/Repair

0 Deepen O 0 Uter

® Destroy 0eKNJ• proccmJres and materia\1 undtr '"OEOlOGIC LOG~

Planned Usea 0 Waler Supply

in □Domestic □Public 'vi □ Irrigation □ Industrial ~ m w

0 Cathodic Protection 0 Dewalering 0 Heat Exchange 0 Injection ® Monitoring 0 Remediation 0 Sparging

Soult! 0 Test Well

Ulln..-a~ °' desc:11bci chtanoe ~•wc•~~•·o.ct•\~lflii kflen. 0 Vapor Extraction

rtt«•~ !IC. and altKh. ma,. Ula~~~! M n.ttnu.tr 0 Other ......... .. .. ,.ll,_. ilftd t;<ifmllda.-

Water Levfll and Yfeld of ComDletod We.II -

Depth to first water (Feet below surface) Depth to Static Water Level (Feet) Date Measured

Total Depth of Boring 49.2 Feet Estimated Yield • (GPM) Test Type Total Depth of Completed Well 37 Feet

Test Length (Hours) Total DraWdown ___ (Feet) ·Mav not be reoresentetive of a well's lono term yield.

Casinos Annular Material Depth from Borehole

Type Material Wall Outside Serean Slot Size Depth from Surface Diameter Thlckne5s Diameter Type if Any Surface Fill Description Feel to Feat rlnc~e.J llnchesl /Inches) Onche,l Feel ro Feet

Attachments Certification Statement D Geologic Log I, the ur,ders;~~ed, certl~~~at lhis report Is complete and aceurate to lhe best of my knowledge a.nd belief D Well Construction Diagram Nome Woo waid b ri r ... tne:

!>Men, Firm Of Cc,pom~QII D Geophysical Log(s) r-M River Road R[Q~sta ....QL 94571 □ Soll/Waler Chemical Analyses /Im,. A~ss /,U~ .Clly SIQIJ lJp [ZJ Other Permit Signed ~_,_.n t?... '_J, r&./ '817114 710078

Al!n¢11 Qddl~a ~ ,n!Otmlll<OO ~ 11 OJ<IOI" C•57 ~IC:Onsf6 W01'1< WoCl C<>J\lnk!O< Date Signed C-57 License Number DWI< 1138 REV 112006 IF ADDlflONAL SPACE IS NEEDED. use. NEXT CONSECUTIVELY NUMBERED FORM

·The lree Adobe Reader may be used to v,ew and complete this form. However, software must be purchased \o complete. save, and reuse a saved form . File Original with DWR State of California OWR Usl!I On! - Co Not Fttl In Page 1 01 4 Well Completion Report I 1 1 I I I

Rltlt:t 11> '/n,11111q,!)11.P.,iml)l)1e1 Stale Wall Number/Site Number Owner's Well Number v..g· No. e0226150 \ 1 ! 1 IN I I

I I I 1 OateWo;k8egan-9eJ42~4 O'\.fl,fq Oat~Wotl<Ended-,11!5/2QM' 0%,t-z.-ttJ ' LaUIUd!) Longltudr, 1..oca1 Pe,mu Agency Santa Ctara vanev Water orstnct I I I 1 , , Permit NumbP.r Pern~t Date IIP~fTRS/Otber Geologlc Log WellOWnor

Orientation @vertical 0 Horizontal OAngle Spedty Name The l-lomax Grau[.! Drilling Melhod Hollow Stem At,gor DriU1n11 Fluid Mailing Address 1835 Berkley Blvd11 Suite 101 Depth-from Surfaco Description

fMl to Feel Oes:crlbo materlat ar.itn size. color. etc Citv Bellingham State Wa Zin 98226 0 5 Concrete Cap Well Location s 33 Portland Cement/Premium Gel Address NE s[d~ of Qeo11al E-x1;1reSSWiJl( §W 12 j Q Villa s1

City Mounts1ia ~i~~ county Santa Clara

Latitude N Longitude ____ _.JJ>J c;----.;r.;:-s.c:- Dea. Min. Sec. Datum Dec, Lat. Dec. Long, APN Book 154 Page 02 Parcel NA Township Range Section

Location Skotch AcOvltv (S~eldl. ms~I ~a <IIIIWJl b'I hand Dftor rocm Is Mnll>Cl,l O New Well North 0 ModillcatlonJRepalr

0 Deepen 0 Other

® Destroy O.ac:ribe ptoeedurH and mf'tOIUll!i undor -GEOlOGIC Loo·


;;; D Domestic D Public ;;; D Irrigation □Industrial ~ ~

0 Cathodic Proteclion 0 Dewaterlng 0 Heat Exchange 0 Injection ® Monitoring 0 Remediation 0 Sparging

Sol/th 0 Test Well

Jl~»k ot dctctlb~ dnil.lnce ftfwd: from roada. buildlr.lJI, hmc111, 0 Vapor Extraction

,._.,.,,t~. and-etlach a m11p UH •M!M~tl Da;>Cf flnot<'\Mf" 0 Other P~ beaca:l#!lbt ~ t:orno'-'•· Nater Level and Yield of Cornoleted Well Depth to first Willer (Feet below surface) Depth to Static Water Level (Feet) Date Measured

Total Depth of Boring 33 Feel Estimated Yield • (GPM) Test Type Total Depth cf Completed Well 28 Feet

Test Length (Hours) Total Drawdawn ___ (Feel) ·Mav not be reoresentallve of a well's lomi term Yield.

Casincis Annular Material Depth from Borehole Type Malarial Wall Outside Screen Slot Size Oopth from Surf•ce Diameter Thickness Olamn\er Type If Any Surface FIii Description Feel lo Feet finches) finches) Cinches) (lnch8!il Fool lo F 1>.et

Attachments Certlflcatlon Statement 0 Geologic Log I, the undersigned. cerllrn !hat this report Is complete and accurate to \he besl of my l!nowfedge and belief D Well Construction Diagram Name Woodwarg Qril lng QQ, Ins,; D Geophysical Log(s) Person, f'lm1 or c,,,pt,m.1Jon

550 River Rn:orf Rjo Vista Ca 9~5Z1 D SoU/Waler Chemical Analyses /1 ~. t,<l!jlu~• ../ OIY si; Zip [Z] Other Permit Signed ,,,,/.,, __ r ,,, Inn....11 ,..- 8n/14 710078 Anocn nckif~a,1;11 ,nro,matl<Jn 1111 on1i.. C-57 l.iC<!nwo Wiritr "'1-Gll <:onlnsclo, Dale Sianed C-57 License Number DWR 1 Ba REV 1/2006 IF ADDITIONAL SPACE IS NEEOED, USE NEXT CONSECUTIVELY NUMBERED FORM

"The free Adobe Reader may be used to ~lew and complete lhis rorm. However. software must be purchased to cornplcle, save, and reuse a saved rorm. File Original with DWR State of California

Well Completion Report Page 1 of _1_2___ Roferto fnslrutlJOn Pamphlol

Owner's Well Number -'V'---'-1-=-0_________ No. e0229471 Date Work Began 05!12'/201 4 Date Work Ended -5-/1-5_/=2=0~14~---Local Permit Agency Santa Clara Yaney Water District Permit Number 13D00565 Permit Date 12/12/13

Geologic LOQ WeU Owner Orientation ®Verlical 0 Horizontal OAngle Specify Name The Homax Grouo

Drilling Melhod HOiiow Stem Augur Dtilling Fluid Mailing Address 1835 Barkle:t Blvd., Suilg 101 Depth from Surfsce Descr'lp11on

Feel IO Flli?l Oesc:liba m:lleffal aJaln size. CQior a1c CltY Bellingham Slate ~ lp ~226 0 5 Concrete Cao Well Location 5 38 Portland CemenUPremium Gel Address Near 1710 Villa Street

City Mountain V iew County Santa Clara

Latitude N Longitude ______ --..:JV o;;;-~~ Dea. Min Sec

Dalum Dec. Lat . Dec. Long.

APN Book 154 Page 04 Parcel 013 Townshlo Ranoe Section

Location Sketch Activltv ISklllCb mlul ba cimv,,, b• lliWJ rilll!rl""" ll n<lnloll.1 0 New Well

North 0 Modification/Repair 0 Deepen 0 Other

® Destroy 0c$(':;l'Jba p,OC<!dutcis aod m.a1&11al:i; undar~CEDLOCtC..LOG.~


D Domestic D Public 1n rJ □ Irrigation D Industrial ~ w

0 Cathodic Protection 0 Dewatering 0 Heal Exchange 0 Injection ® Monitoring 0 Remediation 0 Sparging

Soulh 0 Test Well

1t1u11,l.r,]!o or llc.,cnoo a1sl.af\Cfl or i,,,e• f'lion,JI'> ttJ~ build•n11h. fonco& 0 Vapor Extraction

rr,~. C olnrl a1h1Ch 1.1 m.1p. Uw ac1c:1,UonaI papf!-r II neceSSllry 0 Olher P4tri.·llit • C,QU"a1- alMI i:omplua

Water Level and Yield of Completed Well Depth lo first water (Feet below surface) Depth lo Static Water Level (Feet) Date Measured


Total Depth of Completed Well Feet Test Length (Hours) Total Drawdown ___ (Feet) 'Mav not ba 1epresenIatlve or a well's tong term yield.

Cas\ngs Annular Material Depth from Borehole Type Material Wall Outside Screen Slot Size Depth from

Surface Diameter Thickness Diameter Type If Any Surface Fill Description Feel 10 Feet (Inches) !Inches) !Inches) (Inches) Feel lo Feel

Attachments CertificaUon Statement D Geologic Log I. the tinde,-slgned. certlf~ that this report is complete and accurate to lhe best of my knowledge and belief D Well Construction Diagram Name Woodward D r-ii Ing QQ. Inc

D Geophysical Log(s) Pora0tt, iii or Corpora1,on

550 River Roa RfoVisla CA 94571 D Soil/Water Chemical Analyses ~ ,_" h,_ 1.,J.......,-'- -~ _r18/28/14 Slolo Zip

IZJ Other Pertnjt Signed 710079 I A11ach adriillor,al inl0ITT1allon. if it eic,s1s C-57 Licen>ed W/.l,ir]Noll Cl}l'>ll3tl0f Dale Sioncd C-57 License Number OWR 188 REV 112006 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM

'The free Adobe Reader may be used to view and complete this form. However, software must be purchased lo complete, save, and reu$e a saved form. File Original with OWR Slale of California 0\11/R. vse Onl - IJo Not Flll In Page 1 of _4__ Well Completion Report

Rater lo 1m11ut;11on />,Jmphlel Owner's Well Number ....;V;...-..:.10_A ....... _______ No. e0226148 Date Work Began 05/12/2014 Dale Work Ended ~5.._/1.,_,5""/""20,._1.:.;4'-----Local Permit Agency Santa Ciara VaUev WBler District Permit Number Permit Date

--~---==S;;;la:;.:;to;:;...:..W.:.;;ut;r..l ..;Nt<m1>erlSit11 Number I I I I IN I I I I I I tolttudo 1.ot,9lt11de

! I I I I I I I

!WI

APN/iTRSIOlher

Geologic Log WellOWnor Orientation 0Vertica1 0 Horizontal 0Angle Speclfy Name The Homax Gro!.m Onlllno Met~Oll Hollow S11tm Au11er Or11ling Fluid

Mailing Address 1835 BarkleJl Blvd., Suite 101 Depth from Surface Descrfptlon Fl!.Ol lo fact OesClibo materfal, nroln &ize color 1110 Cltv Belllngaam State~lp 98226

0 5 Conc"rete Cao Well Location 5 36 Portland Cement/Premium Gel Address UJQ :illlla SI

City Mountain Vi~w County Santa Ciera

Latitude N Longitude ______ __;JV ~ ~ ~ Dea. Min Sec

Datum Dec. Lat. Dec. Long. APN Book 154 Page 02 Parcel 002 Townshlo Ranae Section

Location Sketch Actlvitv l~c/1 IIMII llcl dnlwn bV-hancl llllor tom, 1, Dn~tllcl.l 0 NewWeU North 0 Modiffcation/Repair

0 Deepen OOlher

® Oeslroy n-ue,~pce,ul).JlnM!d, ~"GR>LOr.lClOG•


I 1n □Domestic □Public .. D Irrigation O lndustriel w

0 Cathodic Protection 0 Dewatering 0 Heat Exchange 0 injecUon ® Monitoring 0 Remediation II 0 Sparging

South 0 Test Wei\

r::,~~:'!ffh:ti°:':_:ti.~==~~· 0 Vapor Extractfon

,_,.,.x,......ond ·c.omol,M_ OOther

Nater Level and Yield of Comoleted Well Depth lo first waler (Feet below surface) Depth lo Static Water Level (Feet) Date Measured

Total Depth of Boring .36 Feet Estimated Yield • (GPM) Test Type Total Depth ofCompleled Well 35 Feet

Test Length (Hours) Total Drawdown ___ (Fee1) 'Mev not be representative of a weirs lon11 term vield.

Casings Annular Material Depth hem Boroholo Type Material Woll Outeldo sc,.,m Slot Sire Depth from SUrfi!IC8 Diameter Thlckn~• Diameter Type If Any Surfac11 Fill Oeacrfpllon Fool to Foci (Inches) Oncilesl l lnchasl On~hesl Feet lo Feet

Attachments CerUfrcation Statement □ Geologic Log I, the unt1ers13neo, certilri;lhal thfs report is complete and accurate to the besl of my k"owtedge and t)elief □ Well Construction Diagram Name ~OQ w~[S! Ori! Ing Co. Inc · D Geophysical Log{s) l'l:r$on; Firm orCaJ,cmfi1111

~QQ Biv§r Rgag Rig Vista ~ 94571 D Soll/Waler Chemlcat ~nalyses ~ ""ddress City Stale Zip IZJ Other Permit Signed ';fL, f: ~ 8/7/.14 710078 A,Uad'l widjl10MI lllf"'""'""ltOf'\. tt' ti DXif.1$ ~7 ~W•l(!I WeJICMlnl~l<H: Date Signed C-57 License Number DWR 188 REV 1/2006 IF ADDITIONAL SPACE IS NEEDED, USE NE.XT CONSECUTIVELY NUMBEREO FORM

•The free Adobe Reader may be used to view and complet11 this form. However, software must be purchased to complete, save, and reuse a saved form. File 0nginal with DWR Sta.le of California DIIVR use Onl - Do Not FlU In Page 1 01 4 Well Completion Report

Refer to lnslrudion Pamphlet Owner's Well Number V-11 No. e0226152 Date Work Began 05/12/2014 Date Work Ended ..,.5,_/1...,5.,./2,..0,._1.,__4,__ __ _

State Weff 'Nurnt>ar/Site Number ,-----.-,-.....1--'-'-, "-'T'I N'-',! 1 , , I , Lollludc Lon9i1Ll de

lwl Local Permit Agency Santa Clara vauev Water Djstrjct Permit Number Permit Date APNITRS/Olher

Geolo11lc Log Well Owner Orlantatlon ®Ve11lcal OHorizontal OA11gle Specify Name The HQWs!~ GrO!:!fi! OrlU/n11 Method Hollow Stem A11gor Drilling Fluld

Mailing Address 1835 Barkley Blvd., Suite 101 Depth from Surface O&&ariptfon Feel lo F:oet DOJCrllle material· alllln. ,iz.c. color etc Citv Belli□sham Slale ~ IP 9822§

0 5 C_oncrete Cap Well Location 5 42 Portland CemenVPremium Gel Address 1ZjQ ~Iii! §t

City MO!:!Dllllt! l!l~w County San1a Clara latitude N longitude ____ __JV ~ ---;;;;;;:-~ DoQ. Min See

Datum Dec. Lal. Dec. Long. APN Book 154 Page 02 Parcel 001 Townshlp Range Section

Location Sketch Aclivltv !Skltld> mus1 be~ D'/ ltancJ 81\tf form ,s Mll!O<I.) 0 New Well

North 0 ModifioationJRepalr ODeepen O 0lher

@ Destroy Oescnbe p1ouclutee Jnd ml'l\tricl" undeu -GEOLOCIC Loo•


1ii □Domestic □Public i,11 D Irrigation D Industrial ~ ..

w 0 Cathodic Protection 0 Dewalering 0 Heat Exchange 0 Injection ® Monitoring 0 Remediation 0 Sparging

South 0 Test Well Niutl1alat11aekm1• 0t1,»n<••t well OIJl 1oio\dl ,~ ~knec1..

0 Vapor Extraction 1Wt-1._rk.. ■I\IJ-d:fth•1MP U1♦~1N'ftC'IIHUC"ti.J;M'p" 0 Other - bo KN- ond ,:.-..,.._

IIVater Level and Yield of Comoleted Well Deplh lo first waler (Feet below surface) Depth to Static Waler Level (Feel) Dale Measured

Total Depth or Boring 41.5 Feet Estimated Yield • (GPM) Test Type Total Depth of Completed Well 41 .5 Test Length (Hours) Total Drawdown ___ (Feet) Feel

'Mav not be reores·entafil,e of a well 's Iona term 1/ield. C~slnns Annular Material Dopth from B<lrthOIO Type Material Wall Outatdo $oreo11 SlotSiu Oopth fram Surface Dlamater Thickness Dlametet Type if Any Surleco- FIil Description Feet la Feel /Inches) Un<1hesl Unct,as} (111c'1es) Feel lo Feel•

Attachments Certification S1atement □ Geologic Log I, the understect cert!~ that lhls repor1.1s,comple1e and accurate lo the ~t ol my knowledge and b.ener □ Well Construction Diagram Name WbQ ard Drll ing "o, Inc . 0 Geophysical Log(s) PaR~:J"' or Cll<pOffillon

Bio Yista ~ !'>'10 River ~fil1 0 Soil/Water Chemical Analyses (bx A4d1u.11 L ,/ O!y s,n1& 7.'1P. III Other Pern,it Signed ·~~ e-;, __ 1, - Sll/14 710078 . .

Altnch -11I0,mt lnfonnauon ~ ii elcis1s C-57 llcOft\l'JW~tat WIIIJ ConullCW Dale Signed C-ST Lrcens~ Number DWR 188 REV 112006 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM

·The free Adobe Reader may be used lo view and complete lhls rorm. However. software must be purchased lo complete, save, and reuse a saved form.

File Orig inal with DWR State or California

Well Completion Report Page 1 of 13 R• f•r 10 /nslruclion P,,mpt,/ol Owner's Well Ni,rnber V-12 No. e0229478 Date Work B1igan 05/~ 0.,.--ll,kt Dale Work Ended ~5~/1~5-/2-0_1~4 ___ _ Local PE!frnlt Agency Santa c1arn-Yaney Waler PbmloJ Permit Number 13000567 Permit Date 12112/13

DWR Uli!I Onl - Do N.;::D:::.l .:.F:::lll'""ln::====:;===::;--i

L t 1 - 1 Slate WeD'Nur11berlSl10 Num~be=r __ _

• , 1 .l..!" 1 r J.. r 1W: '-----'cc-La""!l"'.~...,dc--c- · - .,..Lon.._"'"111.1,...d,..c--~

Li • ..i._l APN·~rr=R~SJ~O~- t~h,...er ___ _

Geologic Log W1tll Owner Orientation ©Vertical 0 Horizontal 0Arlgle Specify Name The Homax Grau~

Drilling Method Hollow $ fun, AU!lni Drilling Fluid Mailing Address 1835 Barkley Blvd. , Suite 101 Depth from Sufface Descrlp!fon

Fnel 10 Feet Oese11011 mnte;!hl. nraln size color. etc City Bellingham Slale Wa ljn 98226 0 5 Concrele Cap Well Location 5 42 Portland Cement/Premium Gel Address Near 1710 Viii~ S!rn~1

City Mountain ~iew County Santa Clara

Latitude N Longitude ______ _JJ ~~~ Oi,a Min. Sec.


APN Book 154 Page 04 Parcel 013

Townshlo Range Sedlon

Location Sketch Activity ISkou:h must bo cl<Ilwn l>v hand niter !Qtm l!l t>M!dd,i 0 New Well

Nonri 0 Modification/Repair 0 Deepen 0 Other

@Destroy m.,scnbo pmcactur.as ~ m .11orllo)I !> 1lll411f·GEOJ..QGIC. LOG"

Planned Uses 0 Waler Supply

D Domestic D Public

~ .;; D lrrigarlon □ Industrial Ill w

0 Cathodic Protection 0 Dewaterfng 0 Heal Exchange 0 Injection ® Monitoring 0 Remediation 0 Sparging

S11utlI 0 Test Well

IIIL1:,.1'.:1!6 or ~u:;a1bo d1il<:1noo ol well tTom ro;uls., Oulk:a.n~!lo, ldllce~. 0 Vapor Extraction

,l'llp\ .,. "'Ml ~•i'Nft U1e .odd,~ P,Wt'I' 1f n~c~"ry 0 other f' llt,n a b• ~ r.w,ii. .1.nd comt11~

Water Level and Yield of Completed Well Deplh to first water (Feel below surface) Depth to Static Water Level (Feet) Dale Measured


Total Depth of Completed Well Test Length (Hours) Total Drawdown ___ (Feet)

Feel ·May not be reoresen1aIl11e or a wen's lonn term yield.

Casinsis Annular Material Depth from Borehole Type Material Wall Outside Screen Slot Size Depth from

Surface Diameter Thickness Diameter Type If Any Surface FIii Description Feel !o Feel /Inches\ (Inches I /Inches\ llm:besl Feet 10 Feel

Attachments CertifJcation Statement 0 Geologic Log I, the undersigned, cert!frr that this -report is complete and accurate lo the bes t of my knowl8dga and belief 0 Well Construction Diagram Name Woodward Ori! Ing Co. Ins.

D Geophysical Log(s) Ptlrcon. Firm or ca.pcr,,ll<ln

CA 550 River Road Rio V1s1B 94571 D Soil/Water Chemical Analyses 1·1 /\ddtn"" f:. b.A-rrJ _, 1Ja12a11 4 Stale Zip

0 Other Permit Signed "..b'k, ~ L....1" 710079 AUach 3dditlonal m1ormA1ion. ir ii ek1~1s C:~ l li:,,,,....i Wn'{, ll'cl Conlraclor Date Sioned C-57 License Number DWR ,ea REV 1/2006 IF ADDITIONAL SPACE IS 1'1~"£0£0 , USE NEXT CONSECUTIVELY NUMBERED FORM

ATTACHMENT 3

WASTE DISPOSAL DOCUMENTS

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NON-HAZARDOUS WASTE MANIFEST ul.'d for use on elile 112 i:, Clll ,l:i Vinlatl

NON-HAZARDOUS WASTE MANIFEST

1 Genera1or's US EPA 10 No.

3 Generalors Name and Malling Address Jasco Chemical site 1710 Villa Street Mountain View CA 94041

4. Genera1ors Phone f

5 Transporter I Company Name

Slaby Environmental Inc. 7 Transporter 2 Company Name

9, Designaled Facilily Name and Srte Address

California Carbon Company 2825 E. Grant Street Wilmington CA 90470 11 WASTE DESCRIPTION

6 US EPA fD Number

N/A B US EPA ID Number

10 US EPA ID Number

Non Hazardous Waste Solid (spent carbon)

b

Manll&St Document No 02565

2 Paget

ol

A, Slate Transporter's 10

B. Transporter t Phone (888) 701-660 C Slate Transponers 10

D Transpo,ter 2 Phone

E State Facility's ID

F Factlily's Phone

12, Containers 13. 14, Total Un~

No Type Quantify WUVol

003 DM 715 LBS

Ei--- -----------------------------1---1-----t-------------R A T 0 1·-----------------------------+--+-----t--------t--------1 R d

G Addihonal Descriptions tor Matanals usled Above H Handling Codes for Wasres l.Jsted Above

15 Special Handling lnslructions and Aeldt1ional Information

16. GE\IIEJlATOFi'S CEm fFICATIOfl; I hereby ~ll<IJ!y It!~ Intl centp,, ~ oc ,s shli>QIMI ~ fully and accu,a1e1y desctibed and are in all respec1S in g1,:,fMI< ccncWla,\ !O' IIRl>Sl)d,1- The matena dooc, a,, rNlflll~ are nol ~1 lo t1wlaraJ hazardous waste regulalions.

0:,1

Pnnlect/Typ,td Name Stgnalure Month Day Year

T Oa1e : 1------------,-----...---++--------=-....-- --,,--------+-+--- ---------------1 N J1----=:..:..:!=::..:C::._ .L:::::'.~:::t1:'.!...2!!.~~:::..J./._ _____ _j_ __ .-::::;:::::::.~-1:=!L..::.:::::__::::_ ________ ..L__L::~ ..l!.,~

0 1 B Transporter 2 Acknowledgemenl of Receipt of Matenals Ri--------------------------.--------------------------------1 Prin1ed/Typed Name Signalure T E R

F A C

19 Discrepancy lndleallon Space

Month Day Year

I t-20- F-acl- lily_ Ow_ne_ r_o_r Ope- ,-.1-or-; C-ert_mca_· - li-on_o_l ,-ece- i-pl-of_lh_e_w_ast_e_m_al-en_a_ls -co-ve-red- by- lh- i,- me- nil-es-l, -ex_ce_pl- as- no-led- ln -rtem- 1-9,-------------------1

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F-14 0 2002 LABE~TER a IIOOl 621 ·5808 www labelmasler com Rev, 3195

NON-HAZARDOUS . WASTE MANIFEST

1 Generalor ID Number

5 Generato(s Name and Ma;I;ng Address

Homax Group 1835 Barntev Blvd. Suite 101 Belingham \NA 98226

Generalor's Phone: 5 -

2, Page 1 of 3 Emergency Response Phoo€ 4. Waste Tracking Number

1 1-BQ0-424-9300_ Generator's Site Address (1f different lhan mailing address,

Jasco Cherrvcal Corporation 1710Villa Stre~t · Mountain View CA 94G41

JH40991-N

U S. EPA ID Number 6 Transponer 1 Company Name

Environmental Lo Istics. Inc. C A R O O O 2 1 ? 5 1 3

a: 0 ti: a:

a ~ted . Nam!! and Sit~~~ Filter Recycling Services. Inc. 180 W. Monte Avenue B!oomngton CA 92316

Facil1 'SPilooe' 809 421-2012

9. Waste Shipping Name and Description

1 Non-Hazardous Wiste Liquid (VlaterWIGrout)

10. Conlainers

No. T)pe

(JO/ J£

U S. EPA 10 Number

CAh9ol41D&""'Yo U.S. , PA ID Num~

C D 11. Total 12 Unil Quantity WINol

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13 Special Hardillg lrlSlroc:6ons uno /ldifitioml nromia~on 1)(L) ~r W Grout- N141t0416 / 1,S- pt-1 1, "1~ '1 G.u.J-t,t\4ll~lb ( '{.Ff y V

iNO #40991-N

14. GENERATOR'S/0FFEROR'S CERTIFICATION: I hereby declare lhat the oontenls of !his consignment are fully and accurately described above by !he proper shipping name. and are classified. packaged matlmd and labeled/placarded, and aJ1> in all •~ in proper conditi<rl IOI transport accmding to applicable intemallonal and national governmental regulations

Gener;." · 1,t1ots Pnnted/Typed Name Signalu Month Day f , . .,,...,

□ Import to US,

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~ 17b. Alternate Facility (or Generator)

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~ 11. f~-s Phone: . O 17c. Sigllil1Ure of Alternate Facility (or GeneralOr) s

_'g Partial Rejeclion

U,S EPA 10 Nutnbe/

MOl\111 Oay Year

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NON-HAZARDOUS 1, Gll/1f111tor1D NurNitl WASTE MANIFEST AO009103318

ai~111~Mt:T~1'e~po'1..:tlon PO B~xJ Mountafn View, CA 94042 Gona1111V, Phoria: 11. Tran~rt11 I ·Company Name, Best u eal 7. T~1149011,, 2 Company N1111•

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~]fa 13. Sptclal HWfl9 IRSt/uc11ons and Adltlionel ln!Olfflliion Charge: Intrinsic Transportation, Inc. PO: 896478-000 OP

2. Page 1 of 3. Emetver,c:y Rasponio Alone 4. W11le l racklllg ltumbef 1 800-321-1030 10071401

Gono11rot, Sh Addr'8S (ii di'!oront tliati mal~ llddms) Former Jasco Chemical Corp. 1710 Villa Street Mountain View, CA

U.S. EPA ID Number

U.S. EPA ID NUmbel

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., 10. Conlalnllll 11. Total 12, Un~

No. Typc Quenllly Wt/o/ol.

1 CM 15

BIN:_:E:-1-1,.12£.--';:f-.,__ __

p!q,et~l clHawdousWute. Monlll Day

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·. 1--- -....,....,.,...-,-.,......- ------- ------ ------ _.::.~=.::ts2"IRt=ft:::r = .!.lNumber.=~· __________ ;.,_ ____ _ --l~ 17b. Alltm•la ~ (or Gtl)Gllllolj US EPA ID NI/ITOH

17c. S(gnalwt ol Allemat, F~lty (or GanotalOI) Moll~ Oily Vear

169-BLC-O 6 10498 (Rav. 8/06) DESIGNATED FACILITY TO GENERATOR

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Transcript of Ltr: System removal & well destruction rpt, w/attchs 1-3