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STATE Or CAIn <br /> LIFORNIA Do Not Fill In <br /> DUPLICATE THE RESOURCES AGENCY 158881 <br /> Retain this copy DEPARTMENT OF WATER RESOURCES N? <br /> WATER WELL DRILLERS REPORT state Well No rr <br /> Other Well No` — <br /> (1) OWNER: (1 I) WELL LOG: (T(� <br /> Name Don Cosa Total depth 141 ft. Depth of completed wan 100". <br /> Address P. 0. BOX 32b Formation: Drscribr by Dolor,cberac)rr,size of maurol,end rera<].m <br /> Tracv. Calif. 0-2 1,.t. Top soil ft. <br /> (2) LOCATION OF WELL: 2-29 Clay <br /> cop.ty San Joaquin Ow -bar if any 2 — Gravel <br /> Township,Ran e.and section T S E n — 0 Clay <br /> Di... from aider,r.,da,ratlroada.et<.211 Albert t. —Albert Gravel <br /> Ct &H mi. North o Durham er —141 Cla <br /> (3) TYPE OF WORK (check): Rd. hastHde <br /> New Well X Deepening ❑ Reconditioning ❑ Destroying <br /> If destruction,describe material and procedure in Item 11. <br /> (4) PROPOSED USE (check): (T) EQUIPMENT: <br /> Domestic ® Industrial [:1 Municipal E] Rotary <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable ❑ <br /> Other ❑ <br /> (6) CASING INSTALLED: <br /> STEEL: OTHER: If gravel packed <br /> SINGLE E] DOUBLE <br /> Gage Diameter <br /> Fcmn l'o or of From To <br /> ft, ft. Dian. Wall Bore ft. fro <br /> 0 100 6 1 01• 11 0 100 <br /> Sav of ahce.r well rinx: <br /> Size of a —t; a <br /> Des r,be;.P, glued <br /> (7) PERFORATIONS OR SCREEN: <br /> Typa.l...t.'anii . .f o, n hand cut <br /> Pesf. Rows <br /> From To per per Size <br /> ft. ft. row ft. in,x in. <br /> go 100 <br /> (B) CONSTRUCTION: <br /> Was a surface sa.itary wl pror;ded] <br /> YtW N. ❑ To whet depth 0 ft. <br /> Were any uuu staled axa�nrz p.11utio.? Yes❑ No❑ If yea,note depsh of strata <br /> Fmm fa.m ft. <br /> From ft.to U. Work warted — 19 -Completed t9 <br /> nerhod of Palo WELL DRILLER'S STATEMENT: <br /> This well was drilled under my jurisdiction and this report is true to the best <br /> (9) WATER LEVELS: of my knowledge and belief. <br /> Uepah at which w as 5ms found, if k.ow. ft. <br /> Surolm, Ned bef.,a perf.ratu.,. If known ft. NAME <br /> son,firm,.r corp.rufonJ (TyDrd ar r]ad) <br /> Studio Imel afrtr rforssinx and devd.pin, 13 ft. <br /> (10) WELL TESTS: Address 2500 1,' <br /> - Fbirable Rd - <br /> W.,pump ter,made? Yea ❑ NoM If yes,by whom] <br /> Yieldr cal./min.witb ft.drawdown after Fn. ISIGNEDI <br /> (Wrfl DIM,) <br /> ical <br /> Temperature of water Was a chemamlylis made? Yes [IN p <br /> Was dot,rlc log made.f well? Yes 0 No If yes,attach copy License No. 299)81 3 Dared 9-8 1 <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 188 (R.o....Rl B_)a 90M TRIP Or osP <br />