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� f � <br /> QUADRUPLIC ? STATE OF CALIFORNIA <br /> //''33 tt(+ „ DD not fill in <br /> Use ofcomplyw AUG 2 i, ,"� i THE RESOURCES AGENCY <br /> local requirements DEPARTMENT OF WATER RESOURCES No. 2431.67 <br /> >.tce:,t latent No-_ SAN JOA '—'N t RIMER WELL DRILLERS REPORT state Well N.,. <br /> I.,cal Permit No. or Dat, _ HEAL 1 H DJS T RgC 3 Other Nell N,,. <br /> ( 1) OWNER: Nan, J-W- F (12) WELL LOG: Tota]depth 175•a. Dopa,of c„mpletnl well 1.20rft. <br /> :%dare v� four, ft. to ft Fomsntion (Describe by nAor, charaMen size or nat,od) <br /> City Manteca gip — 1 <br /> Top Sea— <br /> (2) LOCATION OF WELL (See instmetions): <br /> Gnurty SanjoacpLn Owner's Well Number 71 - n e <br /> Reil address if different Irmo above - <br /> TmonshipI4anYaea Rang Cectio • - <br /> 461 Smd <br /> Distance from cities, roads, railroads,fences,etc. - <br /> 699 - 791 Sand <br /> D, ;.,r (3) TYPE OF WORK: - <br /> ___ _ New Well Id Deepening ❑ / - <br /> - / Sand In Clmy <br /> _._�-- _ 1 _'•� I Reconstruction ❑ - <br /> ---- -� Reconditioning ❑ 971 -1251 Sand <br /> lloriwntal Well ❑ - <br /> Destruction ❑ (Describe - <br /> destruction materials and 1251 <br /> Procedures in Item 12) - <br /> - (4) PROPOSED USE: - <br /> Domestic <br /> Irrigation ❑ <br /> Industrial ❑ - <br /> I. ,)- ._ Test Well ❑ - <br /> Stock ❑ <br /> Municipal ❑WELL LOCATION SKETCl[ Other ❑ - <br /> (5) EQUIPMENT: (6) GRAVEL-PACK: - <br /> Rotary Reverse ❑ Yes J] No ❑ Sirx_ $ - <br /> Cable ❑ Air ❑ Diameter of bore - <br /> Other ❑ Bucket ❑ Packed from > ft 5a-ytu l20 w. - <br /> 1'1 CASING INSTALLED: (8) PERFORATIONS: - <br /> steel v Plastic ❑ Concrete ❑ Type of perforatinu or size of screen - <br /> From To Dia. Gage or From To Slot - <br /> ft. ft. in. Wall ft. I ft. size - <br /> • • 1 - <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yes 10 No ❑ If yes, to depth�_ft. <br /> Were strata sealed against pollution? Yes ❑ No jj Interval �� w, - <br /> Method of .1ig blenbMitA Work start 19 Complet 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if knos. / This tuell was drilled ander m. <br /> 4 <br /> Standing level c weft sflospletion i ft, krmmledge and belief- lon'�n¢ron and this report is one to the best of mp <br /> (11) WEL„ TESTS: - SIGNen <br /> Was well}eat Made? Yes .N.* If yes, by whom? (Well Driller) - <br /> Type of 1040f �eump ❑ f Bailer C) Air lift [3 NAME � <br /> Depth W%N'a[er at tah>'r qE4eat-lt At end of test-�ftrsoa or corps or printed) <br /> Disdsas�7el r =y{@ry�Lpaurs Water temperature ^e Read <br /> Address_ GJ <br /> Chemi '',,�� al sis \ v^.•✓t Ci rlitidake <br /> avq�;tn 1 rdnt7C?r � r ti b* If-yes, by whom? tY ZiP V <br /> lM1'as el' log P N,-Z if yes, attach copy to this report r0- License No. Date of this report <br /> cwR te4�' V,Tam *:,Q.,'A UONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM - <br /> e., r = <br />