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QUADRUPLICATE <br /> Use to comply with STATE OF CALIFORNIA Do not fill to <br /> local requirements THE RESOURCES AGENCY <br /> DEPARTMENT OF WATER RESOURCES NOW' <br /> It a of Intent No. 1346730 I ' WATER WELL DRILLERS REPORT State Well No, <br /> Permit No. or Date - /! k— �t7 W, Other Well No. <br /> 1 ) OWNER: _Name John Morris ota <br /> (12) WELL LOG: Tl depth� izft. Depth of completed wellB. <br /> "Hress- from ft. to ft. Formation (Describe y rotor, character, se or mat a <br /> tst a I nm zip - - <br /> -1) LOCATION OF WELL (See instructions): _ hard pan <br /> omty San JQI&—Qv R Ownees Well Number <br /> .,dl address if different from abo 12 28 rand <br /> — <br /> 1,mbip 1 -S Range 9 E Section 32 7R 32 ;Town clay <br /> in.tuna• tram cities, roads, railroads,leaves, etc. 32 - 48 sand <br /> t <br /> 24 - <br /> �w 64 sand <br /> (3) TYPE OF WORK: 64 - <br /> 76 brown clay <br /> New Wel ] Deepening ❑ 76 84 sand and paw!84 400 saiid atid rock— <br /> 'Reconstmetion ❑ v <br /> Reconditioning ❑ <br /> i <br /> i Horizontal Well ❑ — <br /> Destruction ❑ (Describe iiiit) t32 a a <br /> destmetion materials and i32 136 yellow Clay <br /> procedures m Item 12) <br /> (4) PROPOSED USE: 126 204 bxuwn clay <br /> - <br /> Domestic G 2b4 208 paicked Sand and gravet <br /> — <br /> Irrigation — ' <br /> 2j6 34"d <br /> lodnstrial ❑ — <br /> Test Well O — <br /> Stock ❑ — <br /> Municipal ❑ — <br /> WELL LOCATION SKETCH Other ❑ — <br /> 15) EQUIPMENT: (R) GRAVEL PACK: — <br /> Hutary ❑ Reverse ❑ Yes ❑ No)] Size — r <br /> Cable p Air ❑ Diameter of bore — <br /> Other J❑l Buvket ❑ Packed fro to R. — <br /> r7) CASING INSTALLED: (S) PERFORATIONS: — <br /> Steel ❑ Plastic ❑ Concrete ❑ Tcpe of Perforation mr size of screen — <br /> From To Dia. Gage or From To Slot - <br /> ft. ft. in. Wall ft. ft. Size <br /> (9) WELL SEAL: - <br /> Was surface sanitary seal provided? Yes ❑ No ❑ If yes, to depth ft. — <br /> Were strata sealed aeamst pollution? Yes ❑ No ❑ ]nterval fr — <br /> Method of sealin• Work started 19 Complet 19 <br /> (10) WATER LEVELS: WELL DRILL 'S STATEMENT: <br /> Depth of first water, if know ft. This met[ wm drilled Imdur aw inrisdictfnn and this report ix hue to the hest of n.V <br /> j Standing level after well complatio R, knowledge and belief. <br /> (11) WELL TESTS: SIGNED <br /> Was well test made? Yes r, No f-1 If Yes. by whom? (W'ell Driller) <br /> Type of test Pump ❑ Railer ❑ Air lift ❑ NAMEPA <br /> Depth to water at start cf test —__--ft. At end of lest fr l nrs„n, hmx, or corp,r, r _' Rd) <br /> Discharge. gal/min after hours Water temperature Address— Lone Tree Rm ___ <br /> J <br /> Chemical anNYsis made'? Yes i i No ❑ If Ye, b ? ,� City - — --P— X3361 <br /> Wax electric log made? Yes n No ❑ I a h t rt cense No, ate ,I thfs repo V <br /> DWR 188 ,RFV.]-]alIF ADDITIONA A IS NEEDED. USE T CONSECUTIVELY NUMBERED FORM se,c-ss=r->6 sos,Dano Ch osr <br /> MAY 16 1977 <br /> SAN JOAQUIN LOCAL <br /> HEALTH DISTRICT <br />