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STATE OF CALIFORNIA Do Not Fill In <br /> # THE RESOURCES AGENCY <br /> `'feet in Ahs copy DEPARTMENT OF WATER RESOURCES N? 12258.5 <br /> WATER WELL DRILLERS REPORT State Well No. <br /> Other Well No. 74-1 1-1 1 w <br /> (1) OWNER: (1 1) WELL LOG: <br /> Name Bob Voiinapr Total depth 96 ft. Depth of completed well94 ft. <br /> Address 1 ' " Ste <br /> Formation: Describe by rotor,rbaracter,size of material,and slrvetare <br /> (2) LOCATION OF WELL: 0-5 Tol) soil <br /> CountySan JoaquinOwner's number.if any <br /> Township,Range,and Section ' 18 MAY <br /> Aq <br /> Distance from cities,roads,railroads,etc. Iq 1", Corner ofFig <br /> l try s Shale <br /> ra n <br /> (3) TYPE OF WORK (check) <br /> NEW Well [$ Deepening © Reconditioning ❑ Destroying 37--41 n <br /> If destruction,describe material and procedure in Item 11. Z —49 Sand y <br /> (4) PROPOSED USE (check): (5) EQUIPMENT: 14.9-1%53 clny <br /> Domestic' [I Industrial ❑ Municipal ❑ Rotary X] F; <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable ❑ r <br /> Other ❑ c <br /> (6) CASING INSTALLED: Q ay <br /> STEEL:x OTHER: If gravel packed <br /> SINGLE [K DOUBLE ❑ - <br /> Gage Diameter <br /> Fro n lb or of From To <br /> ft. ft. Diam. Wall Bore ft. ft. <br /> Stat 6i shoe- vrll ring: Sire of 9'.ve]L pea <br /> Describe Dint I <br /> (7) PERFORATIONS OR SCREEN: <br /> Type of perfwatiun or n e of screen czz <br /> Ferf. Rows <br /> From To per per Size <br /> ft. ft, row ft. in.x in. <br /> 84 <br /> !! <br /> i <br /> i <br /> (8) CONSTRUCTION: <br /> War a surface sanitary seal provided? Yes No LD To what depth 50 ft. <br /> Wert any strna sealed against pollution? Yes ❑ No ❑ If yes note depth of strata <br /> From ft.to ft. <br /> I-rmn ft. Work started 19 ,Completed 19 <br /> Method of sealing WELL DRILLER'S STATEMENT: <br /> (9) WATER LEVELS' This well was drilled under my jurisdiction and ibis report is true to the best <br /> • of my knowledge and belief. <br /> Depth at which water was first found, if known fc. <br /> Standing level before perforating, if knnwn ft. NAME Hpnninps <br /> (Person,firm,or corporation) (Typed or prinled) <br /> Standing level after perforating and developing f[. <br /> (10) WELL TESTS: Address 2 00 1,'. 'P li —Ed . <br /> Was pump test made? Yes 0 No If yrs,by whom? h' n <br /> Yield: R.L/rnisi.with ft.drawdown after h— [SIGNED] 49(/ <br /> Temperature of water Was a chemical analysis made? Yes ❑ No X <br /> {Wel!Driller) <br /> Was eleceric log made of well? Yes [7 No If yes,attach copy License No. 74�� Dated 4-6 - - , 19-7-1+ <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE /� <br /> DWR 186 (Ieev. 9.68) <br /> 67199-760 6-7a 3O TRIP Grl OSP <br />