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ORIGINAL STATE OF CALIFORNIA DO HOI fill IH <br /> ORIGINAL li THE RESOURCES AGENCY <br /> File with DWR DEPARTMENT OF WATER RESOURCES No. 22691 <br /> WATER WELL DRILLERS REPORT I `' � I � � " r � <br /> \�rtke of Inletrt Sn. State R'e0 ]n._" ]lam, M— 1 <br /> LMa!Permit N.. or Date_772-1 32rI Other\yell <br /> f t I OWNER: Same (12) WELL LOG: Tota depth l 5fifc Death of lmple a <br /> Address 2-3514 E. Arthur Rd. fmm ft. to ft. Ft rrstinn i Deunbe by color. character. size or material I <br /> ct, Escalon, Calif. zip 95120 O=2 l <br /> (2) LOCATION OF WELL (See instructions): 2 g4 Sandy <br /> Carmt.. San .Ina lin Owl e, NV U Nmnbrr 4=11 Sha e <br /> N%ell address if different from above 11-15 Shale sand <br /> TnISwnship TRanee R9E sactfn 15-25 Sand <br /> Distance fmm cities,mads, railmads,fences,etc Arthur Rd• imi, <br /> WnQt elf Brennan Rd - South gide_ 2 =�2 Sa <br /> 2 Gra <br /> =48 Qla <br /> (3) TYPE OF WORK: 0 yet <br /> New Aveng Deepening ❑ C-la <br /> RMIHISINCtion ❑ 5-8,Q\ San <br /> ll • nd+tinning ❑ —12 C shale <br /> Horizontal Well ❑ - <br /> Destruction [] (Desenbe _ <br /> destmetion materials <br /> procadums fn Item <br /> (4) PROPOSED <br /> Domestic _ <br /> Irngatin ,X44 4I\ <br /> 1 <br /> I.=.al O ❑ - 2 SanV <br /> R'en ❑ 1 6 Gla & sand <br /> St t 6-1 <br /> 8 <br /> Diunici <br /> WELL LOCATION SKETCH Other ❑ <br /> (.i) EQLTPSIEST: (6) GR{ PACK: <br /> RM ry $1 Reverse ❑ (= So Size - <br /> Cable ❑ Air ❑ ter of bore <br /> Other ❑ Bracket ❑ - <br /> (71 CASLSG INSTALLED a (ti ERFOR �S:y rad cut <br /> Steel ❑ +Plastu][) Type of pe 'ono 'ze of scree - <br /> Fmm T Dia. r F To <br /> fL f. in. Wall ft s" — <br /> (9) WELL SEAL: �' � — <br /> R'as mIf."samtan� seal pmsided? yes� No ❑ If yes, M depth_5C —ft- <br /> Were <br /> - <br /> Were strata sealed agafost pallutinn? yes ❑ No ❑ Interval B <br /> Method M selirm Rpntnnite Comptes d 19_ <br /> (10) WATER LEVELS: WELL DRILLER'S STATEME-NT: <br /> Depth of first slater, if k... ft- This aeB runs drilled under any furudwtion and this w,p rt u true to the best of ray <br /> standinE level after wail eomp(etio 6;) ft. knowledge and belief. <br /> (11) WELL TESTS: <br /> {Vas well test made? yes - Sag If ves. by xhom? .t (Il-ell Drii7eri <br /> 7)'e of test Pump 5 Bailer ❑ Air lift ❑ NAME�E171?ingo Ar.O 11 <br /> Pen-m firm. .. tc <br /> ikpth t+r water at star: of res R. A: end of tett " 2 00 41 Rumble Rd <br /> Address 95�50 <br /> Owrni l sae?m Yn :: boon Water <br /> oan't temperansre at Modesto, Calif. lip <br /> Chemrrl anahs6 made? .Yes = Sox If vel, by v�hmm?V <br /> spp <br /> 'kerne <br /> km made? ye. CJ No ' If yep, attapy ch ento Nis report License So. ^ Date of this rep.+ - 8— _ - <br /> U-.t tee rREV.7-7.1 IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM •_vre-sws--a saw euan01 cee <br />