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STATE OF CALIFORNIA Do Not Fill In
<br /> DUPLICATE THE RESOURCES AGENCY 157684
<br /> Retain this copy DEPARTMENT OF WATER RESOURCES N2
<br /> WATER WELL DRILLERS REPORT Stare Well No
<br /> Other Well No. 76,483 W
<br /> (1) OWNER: (11) WELL LOG:
<br /> Name Andrew Rossi Total depth 18 ft. Depth of completed well a.
<br /> Addresstu;P7 00 1111713ort Way Furmarion: Dnrrit,by rdar,rta...trr,size o/maurial,aadMmateca ,nurta.r
<br /> t CaITT . 0 1 fe,n Sand
<br /> (2) LOCATIOF OF WELL: —1 Clay
<br /> County San oaqu n Owner's number,ifany 17-30 Blue sand
<br /> T.—hip.a.n a and serepn0- 2 Clay
<br /> Di, ,,;,road,,,ar. •a or 2— Sand
<br /> s —10 Clay
<br /> (3) TYPE OF WORK (check): 104-107 Sand
<br /> New Well T5 Deepening ❑ Reconditioning ❑ Destroying ❑ 107-115 Cala
<br /> If destruction,describe material and procedure in Item ll. 11 -1 0 Shale
<br /> (4) PROPOSED USE (check): (S) EQUIPMENT: 1 0-1 Send zravel
<br /> Domestic R Industrial ❑ Municipal ❑ Rotary 1] 1 -1 'Shale
<br /> Irrigation ❑ Test Well ❑ Other ❑ Cable ❑
<br /> Other ❑
<br /> (6) CASING INSTALLED:
<br /> STEEL: OTTR:
<br /> If gravel packed
<br /> SINGLE E] DOUBLE op , sti
<br /> LIQ Gage Diameter
<br /> Front 1'. or ofFrom To
<br /> ft. Io. Darn. Will Bore ft. ft.
<br /> 100 1
<br /> Sae of,hoe pwell r;na: S;z of, vel: bird se e
<br /> Deur;be iv,aB u
<br /> (7) PERFORATIONS OR SCREEN:
<br /> Type of piss,, n pr,ame of,erre. hand cut
<br /> Perf. Rows
<br /> From To per per Size
<br /> ft. ft. row ft. in..in.
<br /> 7.5
<br /> (8) CONSTRUCTION:
<br /> War a surface.anlory mal D—idrd? Ye� No❑ To whs,depth 0 f,.
<br /> Were anY.,nn ailed.,elms pollu,ion? Yes❑ No❑ If Yes, ...dep,h of s....a
<br /> Rom ft.- is.
<br /> From
<br /> it.to Is. Work u.rtrd 7—i 19 ,Cosn'k sd 19
<br /> kie,hod of,ealina
<br /> Bentonite WELL DRILLER'S STATEMENT:
<br /> 9 WATER LEVELS: This well was drilled under my jurisdiction and ibis report is true to the brat
<br /> ( ) of my knotvledge and belief.
<br /> Depth as wb;ch water was fire found, if known ft.
<br /> S,anding ievd brf.,e Rrf....ing, if kmwn fc NAMEHennin s Bros. Drillin CO I
<br /> Snndin level afarperfo..tinp and develop;., 15 fs. (Pers n,firm,or cotporn;on) (Typrd o•l+.imrd7
<br /> (10) WELL TESTS: .� Address 2500 W. Rumble Rd
<br /> pwnp tat ma
<br /> W.. dr? Ye, ❑ NottZ If ya,by whom? Modesto f.Cali
<br /> Yield: pal./min.with is.drawdown afnr h— [SIGNED)
<br /> Lmperuure of rater Was a chemical and de? Yes ❑ N� f Wel/Drilln)
<br /> y,i,ma �^
<br /> Was elear;c loq made of well? Yes ❑ NX If yes,a„ach cape License No. 290$1 Dated 7-15 -11926
<br /> SKETCH LOCATION OF WELL ON REVERSE SIDE
<br /> DWR Inn (REV.9.88) 'r-la 9oM TRle01,on,
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