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STATE OF CALIFORNIA Do Not Fill In <br /> DUPLICATE THE RESO�;RCES AGENCY <br /> Retain this copy DEPARTMENT OF WATER RESOURCES 1\�7 <br /> 2 157646 <br /> WATER WELL DRILLERS REPORT State Well No. <br /> Other Well No.?E-3 1 :LT <br /> (1) OWNER: (11) WELL LOG: <br /> Name .1 Or ve a l:lierelll Tore]depth 171 1.. Deprh of ro osdrtrd wdl 1 7nn. <br /> Address I �' 1 • 1'_". 077 i 1' Formed— Dmrribr by colo.,rh..areo, _r o1 me,...at,<nd m.r(ere <br /> n ecr' -if, _i ft.rm a fr. <br /> (2) LOCATION OF WELL: 1 P-1 7 Clay <br /> C....y San Joaquin Deana,',nambn.if any <br /> Towmhi,.Rmae,and Sen TTS 1-6E r_ <br /> oneanre from dun,road,.•nllrn,da.<tr.S. I.it ort c v —l;Mi <br /> North fo w r 1 ?0 rarest side <br /> (3) TYPE OF WORK (cbeck): 76-62 014 <br /> New Well ® Deepening ❑ Reconditioning ❑ Destroying ❑ 1 <br /> If destruction,describe material and procedure in Item 11. - <br /> sand sq, <br /> (4) PROPOSED USE (cbeck): I (S) EQUIPMENT: <br /> Domestic ® Industrial ❑ Municipal F] 'Y <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable ❑ _ c. <br /> Other ❑ <br /> (6) CASING INSTALLED: 125-153 ClRY <br /> STEEL: OTHER: If gravel packed _ P_ czinrl <br /> SINGLE [] DOUBLE <br /> Gage Diameter <br /> From lb or of From To <br /> ft. it. Dia.. Wall Bore ft. ft. <br /> 0 170 C 1 ('0W, i 1001 17() <br /> Sae of,hoe w well ring: S,,e of Rra.el: 'h i r r' r <br /> Ua ribe <br /> (7) PERFORATIONS OR SCREEN: <br /> Type of periorauor or of s n <br /> pe'L Rows <br /> From To per per Size <br /> ft. ft. row ft. in.x in. <br /> 160 70 <br /> (8) CONSTRUCTION: <br /> Wa.—,W,-ornery seal provided? Yes N No ❑ To what depth ft. <br /> Werc my a(uu.ealed agaimr ppllrGon? Yes❑ No❑ If yes,more depth of scram <br /> From fr.to ft. <br /> From fr.to 1,. Work snrmd 1976 Completed 19 <br /> Mahad r1—1-R _ icsnWELL DRILLER'S STATEMENT: <br /> (9) WATER LEVELS: This well was drifted under my jurisdiction and this report is true to the best <br /> o)my knowledge and belief. <br /> Depth a which w r wown h <br /> as fire, fod, if kn . <br /> Standing kad beforepe,f....ng, if known G. NAME it O a f'1 <br /> handing level after pe,faraum, and developing fr. er nr firm,oa or,...Iian) ITYPd or trfa(rd) <br /> (10) WELL TESTS: Address <br /> We.pwrP m made? Yea ❑ No If yes,by whom? M r.. i <br /> Yield: Ral./min.with fr.drawdown after tars. [SIGNED] <br /> Tem f water Was a chemical anal de? Yes ❑ No <br /> Temperature ya. n <br /> War rlec c log made of well? Yea E] No If ya ach ropy License No. 3 Dated 7-1 19 L <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> OWR 108 (REV. 9-681 '.1a]OM Tmp(11 Ote <br />