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STATE OF CALIFORNIA Do Not Fill In <br /> DUPLICATE THE RESOURCES AGENCY <br /> Retain this COPY DEPARTMENT OF WATER RESOURCES N2 110563 <br /> WATER WELL DRILLERS REPORT State Well No. <br /> Other Well No.-75-75-w— <br /> (1) <br /> o.-5-7 w(1) OWNER: (11) WELL LOG: <br /> Name Terra Dcvelopment Total depth 215 f,. De ,h of gpmplend.dl 9101, <br /> Address 5151Formvuon: Dnn;be by rpme,eb.rren,,i:e a)man.;d,ena,r.grexn <br /> l Ta <br /> (2) LOCATION OF WELL: <br /> Courcy San Joaquin Ovner's number,if any <br /> Township,Raoge,and Secuun <br /> Dis,m<e from ckies,roads,railroads,em. <br /> rid , _ <br /> (3) TYPE OF WORK (check): <br /> New WellJ] Deepening ❑ Reconditioning ❑ Destroying ❑ <br /> If destruction,describe material and procedure in Item 11. <br /> (4) PROPOSED USE (check): (I) EQUIPMENT: 115-126 Rz,nA <br /> Domestic ❑ Industrial ❑ Municipal ❑ Rotary �] -Illp Play] Test Well ❑ Other ❑ Cable ❑ <br /> Other ❑ r e <br /> (6) CASING INSTALLED: <br /> STEEL OTHER: If gravel packed 2-nd <br /> SINGLE DOUBLE E] 1 !75-180 (�[ <br /> Gage Diameter <br /> From 'Ib or of From To 20q 215T:. uc� _ <br /> ft. ft. Diam. Wall Bore ft. ft. <br /> 0 9`10 161 <br /> Site of ab«er well rinx: Sire of anvil: hirdsaye— <br /> ucae4 i+ins <br /> (7) PERFORATIONS OR SCREEN: <br /> Type pf perfarniun ter Dame of ween <br /> Perf. Rows <br /> From To per per Size <br /> ft. ft. row ft. in.z in. <br /> (a) CONSTRUCTION: <br /> Was a s«face saninry seal provided? Y Nn ❑ To wh.,dep,h 12 f,. <br /> Wer enr s obd axil t pollut Yes❑ No❑ If yes a depth of n <br /> From f,. ft. <br /> 1-- It.ao ft. Work parted 19 ,Completed 19 <br /> Ne,hod of aedinp 201, c WELL DRILLER'S STATEMENT: <br /> 9 WATER LEVELS: This "ll was drilled under my jurisdiction and Ibis report is true to the best <br /> ( ) of my knowledgeand belief. <br /> Dep,b at which v r v firs,found, if koovo f . <br /> Sunding lewd befarepe.forailnx, if knnwn Er. NAME <br /> Ipermn,arm,pr rarppratmn) I4;g pr�rsntep <br /> Standing level after erforaling and devdu ing Ec <br /> (10) WELL TESTS: Address P5QO lj <br /> Wes pump ma,..5�O an? Yn No ❑ 1(yes,by whom? <br /> Yield: ..l./min.with ft.drawdown after hrs. [SIGNED] <br /> WrII rMfn <br /> Temperature of vnn Was v chemical analysis madei Yes ❑ No <br /> Was el« c log made of well? Ye, ❑ No If yes,at.eh c.Py License No. 24OS1 I Dared K-1,— 1 9 --, Iq-5�— <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 188 tREV. 9-661 .'nn-n..'...M TRle OT..I <br />