Laserfiche WebLink
Customer obtained permit <br /> QUADRUPLICATE STATE OF CALIFORNIA Do not rill in <br /> Use of tz W*lNNfWth THE RESOURCES AGENCY <br /> localrequlremenh DEPARTMENT OF WATEt RESOURCES No. 168813 <br /> .,,uee of Intent No. __ _ WATER WELL DRILLRS REPORT — <br /> Lotal Permit No, or Date {IOtth�heerqr Well Nei._ <br /> (1) OWNER: Name (12) WELL LOG: Total depth-1l�_&. Depth of onmpleted welly h. <br /> Address 646 S. California AVe* from ft. to ft. Formation (Describe by ailor, rharatteq size or material) <br /> City Stockton, Calif. i95208 0 - 6 clay <br /> (2) LQCATLON OF��WELL (Seeinstructions): - `Sand <br /> County oan .J+Oaq!" Owcea's Well Number - 22 Clay <br /> R"ell address/ if different from above 22 - `26 Sand <br /> T,wnshi,NA12 -Aon Range Sectio <br /> Distantt from cities, roads, reilmads,fentts,etc - iiancl <br /> Y <br /> Sand <br /> - Clay <br /> (3) TYPE OF WORK: - <br /> 18171 Sand <br /> New Well Deepening ❑ 97 - 9L clzy <br /> Reconstruction ❑ 9L - 1033and <br /> Reconditioning ❑ 0 - 107Cls <br /> Horizontal Well ❑ - -I <br /> Destruction ❑ (Describe 10 - 112 Stand <br /> d.atroproceduresa. <br /> materials and y 1 _ 11 r <br /> procedures in Iter 1271 N <br /> ay— <br /> (4) PROPOSED USE: 11 - 12 Sand <br /> Domestic ply x 127 - 121 clay <br /> Irrigation ❑ 131 - 1 P <br /> and <br /> Industrial ❑ - <br /> Test Well ❑ - <br /> 56mk ❑ - <br /> Municipal ❑WELL LOCATION SKETCH Other ❑ - <br /> (S) EQUIPMENT: (6) GRAVEL PACK: <br /> But., Y Revers ❑ YesjLD No ❑ Si.VLO0f71nZ - <br /> Cable ❑ Air ❑ Diameter of bow Is_ - <br /> Other ❑ Bucket ❑ Packed from 50 to�K. - <br /> (7) CASING INSTALLED: (8) PERFORATIONS: - <br /> Steel ❑ Plastid] Concrete ❑ Tvpe of perforation or size of screen - <br /> From To Dia. Gage or From To Slot <br /> ft. ft. in. Wall ft. ft. size - <br /> 0 3.55 160155 <br /> - <br /> PS - <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? YeW No ❑ If yes, to depth-450—ft. <br /> Were strata sealed agaivst Pollution? Yes ❑ No ❑ Interval ft. - <br /> Method of waling_ n on to Work started 19_ Complet 19_ <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if known ft. Thi, well was drilled under my jurisdiction and this report it tnre to the ben of my <br /> Standing level after well completi g, knowledge and belief. <br /> (11) WELL TESTS: SIGNED Bkkpr, <br /> Was well test made? Yes ❑ No ❑ If yes, by whom? f Well Driller) <br /> Type of test Pump ❑ Bailer ❑ Air lift ❑ NAME Calwater Drilling Co., Inc. <br /> Depth to water at start of test ft. At end of test ft (Person, finre� r corporation) (Typed m printed) <br /> Dhx,h.ge cal/min after hours Water temperature Address 330�0� S I1il io <br /> Chemical analysis made? Yes ❑ No ❑ If yes, by wham? City Turlock. Calif -----Zip 9530V <br /> Was electric Ing made?_ Yea ❑ No ❑ If yes, attach copy to this report License No. 323.252 Date of this repo <br /> DWR tae (REV.7-7e) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br /> r i <br />