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QUADRUPLICATb <br /> Use to comply with STATE OF CALIFORNIA DO not rill in <br /> j localrectzirements THE RESOURCES AGENCY No,3449�' <br /> - DEPARTMENT OF WATER RESOURCES <br /> ,ti.a of Intent No. 134632 WATER WELL DRILLERS REPORT State Well N..--- <br /> Local <br /> o. _- <br /> Lienal Pemrit No. or Date 77-460 W Other Well No. <br /> (1) OWNER: Name (12) WELL LOG: Total depth2,WR. Depth of completed <br /> b Address 13440 S Anstin Road franc ft. to ft. Formation (Describe by color, character, size or material) <br /> f Manteca ip-953347 sand <br /> 2) LOCATION OF WELL (See instructions): 12 6A Clay_ <br /> r,nurh an �joaquia Owners Well Number <br /> 1 . sand <br /> Nell address if different from above <br /> lowwhip 1 Range 7 Section 23 _ 9.2 !1a wand <br /> I cA...e from cities, roads, railroads,fences,etc. 1100 #[`('t NA ct __ 22 hard brown eta? <br /> of Austin Road hehind addrifasS 1,111 <br /> 364 - 176 &%ad and rock <br /> 176 ISO s and <br /> (3) TYPE OF WORK: 180 - <br /> 196 br-own G levy <br /> `�� New ing ❑ - <br /> jReconstruction ° 200 = 216 brown c la; <br /> I ` ReemadiHoning ❑ <br /> 216 224 sand <br /> Horizontal Well ❑ <br /> _ Destruction ❑ (Describe = . <br /> destruction materials and <br /> - <br /> procedures in Item 12) <br /> ( (4) PROPOSED USE. - <br /> pell- seal war,Domestic ❑ <br /> Irdgafipn - <br /> Industrial ❑ - <br /> Test Well ❑ - <br /> I <br /> Stock Cl <br /> Municipal ❑ - <br /> WELL LOCATION SKETCH Other ❑ - <br /> (5) EQUIPMENT: (S) GRAVEL PACK: - <br /> Botary ❑ Reverse ❑ Yes ❑ No I Size - <br /> Cable Air ❑ Diameter of bore - <br /> Other ❑ Bucket ❑ Packed fn+rn toJr. - <br /> (7) CASING INSTALLED: (N) PERFORATIONS: - <br /> Stee b Plastic ❑ Concrete ❑ Type of perforation or size of screen - <br /> From To Dia. Gage or From To Slot - <br /> ft. ft. in. Wall ft. ft. size - <br /> 0 IRA <br /> (9) WELL SEAL: - <br /> Was surface sanitary ,al provided? Yes�3 No ❑ If yes, to depth ft - <br /> r <br /> Were strata sealed acaimt pollution? ]rs ❑ No ❑ Interval R, - <br /> Method of seahm, Work started-4/2-9L-19 Cum➢]et .19-77— <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if know t This .,If war drilled under no iuriolarion and thm rrporx is Imo v+ rhe best of mo <br /> Standing level after web com➢letio,. [{, kmmdedge and Helie). <br /> (11) WELL TESTS: SIGNED <br /> Was well test made? yes f No fl If yes, by wham? (Well Driller) <br /> Type of test Pnm, 1 Bailer ❑ Air lift ❑ N e D.1E t s - <br /> Depth to water at slart of test_ __._it. At end of test ft- l ennq lien!, ur enrpprahon ed nr prm ) <br /> Discharge__ —_ —gal+min after halm Water temperature Achl"'31450 It. Lane Tree RMd — ---- <br /> Chemical nod's.' made'! ties r I No ❑ U yes, by whom?_ CityOakdale <br /> Liv - <br /> IWas eleetrir log made? Yes ❑ No ❑ If. attach ropy to this report License No. areof Nes rep+ <br /> OWR lea GREY.7.70+ IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM +srs-ssc r-s ecru Runo Ch osr <br /> I <br />