Laserfiche WebLink
WWRUPLICAU STATE OF CALI FORN I A <br /> FTOM THE RESOURCES AGENCY Do not fill in <br /> IM DEPARTMENT OF WATER RESOURCES No. 197559 <br /> Sake of Intent No. WATER WELL DRILLERS REPORT <br /> focal Permit No or Date 96-29- State Well No. <br /> Other Well Nn. �- <br /> ( 1) OWNER: Name Tom,_ i99 n (12) <br /> 2L[1 1 WELL LOG: .Taal dap by?? ft. Depth If e,�mplemd ,,I]—loft. <br /> lddrese A 1tin Rd <br /> from ft. to ft. Formation (IJescribe by color' channel', sive nr material; <br /> 2) LOCATION OF WELL (Seeitmtruetioms): Sand <br /> "In San Joaquin Owner's Well Number - <br /> ell address if different from above 2 <br /> Fine red—sand— <br /> Bsandrown ala <br /> i,.,rnship <br /> a"g `eCti° - Fine brow'► <br /> .)i ranee from cities, meds, miln,ads,fences, etc _72 76 <br /> —(Any <br /> (3) TYPE OF WORK: <br /> New WeBX] Deepening ❑ _ Q <br /> Reconstruction ❑ _ <br /> Reconditioning ❑ <br /> Horizontal Well ❑ _ <br /> Destruction ❑ (Describe <br /> destruction materiels and <br /> Item,Promdurce, in 12) _ <br /> (4) PROPOSED i VSE., <br /> ,, - <br /> Domestic nz vat@ W. <br /> Irrigation ❑ _ ti <br /> Industrial ❑ _ r! <br /> Test Well ❑ _ (� <br /> Stank ❑ _ <br /> Municipal ❑ _ <br /> WELL LOCATION SKETCH Other ❑ - , <br /> (5) EQUIPMENT: (6) GRAVEL PACK: <br /> Rotary Reverse ❑ Yew No ❑ Sizc F,nt _ 10 - <br /> Cable ❑ Air ❑ Ui:nneter of bmk 1jp _ <br /> ()ther ❑ Bucket ❑ Packed from 50- to— 14O_(t. - <br /> APR 21 1986 <br /> (7) CASING INSTALLED: (H! PERFORATIONS: _ <br /> Steel ❑ P]as[iC Concrete ❑ Type.,f perfnnitioo or n4 of screen ENVIROAAENTAI_ II <br /> From To Uia. Gage or From To Slot = <br /> ft. ft. in. Wall ft. ft. size <br /> 17C 1 <br /> (9) WELL SEAL: _ <br /> Was surface sanitary seal provided? Yes 6I No ❑ If yes, to <br /> Were stmm sealed against pollution? JYCes ❑ No ❑ let .. w _ <br /> Method of sealln <br /> Workstarted 19_ Complete I9 <br /> Dept a first <br /> LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth rs[ water, if know n (t <br /> Standing level after well completion <br /> This wall was drilled under my {nrisdiction and this report is tree to the best of my <br /> [t, ledge and belie{. <br /> (11) WELL TESTS: SicN'>;n / <br /> Was well test made? Yes ❑ No ❑ if yes, by whom? <br /> Type of tet Pump ❑ Bailer Ll Air lift ❑ (WeB Driller) <br /> NAME j�p�c mon <br /> llepdr to water at start of test ft. At end of test H anon, rm, or rmrpom run-1'Yyptt/eir ptlnte�$ <br /> Discharge gal/min after- hours Water temperature Address <br /> Chemical analysis made? Yes [INo ❑ If yes, by whom? City Zirleek, Calif• Zip ��;�� <br /> Was electric lug made? Yes ❑ No El If yes, attach copy to this repnrt License No. ate of this repo a <br /> DWR tee (REY.7-]6) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br /> 'I <br />