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Customer Obtyined permit i <br /> ORIGINAL STATE OF CALIFORNIA Do not fill in <br /> THE RESOURCES AGENCY <br /> 11e with QW� DEPARTMENT OF WATER RESOURCES No. 187163 <br /> rf Intent No. WATER WELL DRILLERS REPORT <br /> 00 State Well No. <br /> Lam,.. Permit No. or Date , Other Well <br /> f/} <br /> (1) OWNER: Nam r (12) WELL LOG: Total depth-_3 2ft Depth of completed well d!8 ft. <br />,Address 2120 Wilcox Road from ft. to ft. Formation (Describe by color, character, size or material) <br /> City Stockton Calif. Zip 20 - 25Clay <br /> (2) LOCATION OF WELL (See instructions): 25 Gravel <br /> County L Owner's Well Number 27 _ <br /> 6 <br /> 50 Clav - <br /> Well address if different from above 11th St. 0 - Gral—T&I, <br />'Township ange_ r� 1� 62 J <br /> ,Sectie <br /> Distance from cities, roads, railroads,fences, etc. 62 - 2 <br /> 2 150 CT_�r <br /> 150 - 20 Bl:tie Cla <br /> 20 - 21 Sand <br /> (3) TYPE OF WORK: 21 2 \''Blue Cla <br /> r � New Weil �t Deepening ❑ 24. Sand <br /> Reconstruction ❑ 263 - 9 C16 light blue <br /> Reconditioning [] c. - 287 ' a•�i <br /> Horizontal Well <br /> ❑ 7, - 22 C1' �. <br /> ti <br /> Destruction ❑ (Describe ••.,� 1/- �� <br /> destruction materials aAd <br /> procedures in Item 1lit <br /> (4) PROPOSED t3SE:' <br /> DomesticI'1V <br /> Irrigation ❑ <br /> Industrial `�`� `E.' ❑ ;-. - �\4 <br /> Test Well l 0 <br /> _ <br /> Stock.'-, <br /> Municipal' ❑. - - <br /> WELL LOCATION SKETCH Other ❑ <br /> (5) EQUIPMENT- (6) GRAVEL-PACK. <br /> Rotary Xj Reverse ❑ Yes$j No ❑ Size <br /> Cable ❑ air ❑ 1,=Dr�aveter of bore - � _ <br /> Other ❑ Bucket 0 Packed from ,�o'^� <br /> 1t _y� <br /> (7) CASING INSTALLEI):, (8)'`PERFORATIONS: V - <br /> I Steel ❑ Plastic Concrete Q Type of perfoatian or`size of screen <br /> From To —~kDia. Gag4 or FIt�I � To <br /> Wall ft.. �. ft. r size <br /> 0 185-1 60 a - <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? YesM No ❑ If yes, to depth 150 ft. _ <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval F+. <br /> Method of sealin Work started. 19 Complet 1986, <br /> (10) WATER.LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if known_ ft. This well was drilled under my jurisdiction and this report is true to the best of my <br /> Standing level after well completion ft, knowledge and belief. ter, u <br /> (11) WELL TESTS: SIGNEn <br /> Was well test made? Yes ❑ No ❑ If yes, by whom? (Well Ijriller) <br /> Type of test pump [__1 Bailer [] Air lift ❑ NAME <br /> Depth to water at start of test ft. At end of testa ft (Person, firm, or corporation) ( yped or printed) <br /> rge AddressKilroy <br /> gal/min after hours Water temperatwe '��7"�bC`k �',�� � f. zi <br /> 'al analysis made? Yes ❑ No ❑ If yes, by whom? Gin J-—+ ! p "O <br /> Was electric log mnde? Yes ❑ No ❑ If yes, attach copy to this report License No_�t,�w21$ -Date of this repo <br /> OWR tae (REV.7.7al IF ADDITIONAL SPACE 1S NEEDED. USE NEXT,CONSECUTIVELY NUMBERED FORM <br />