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QUADRUPLICAU STATE OF CALIFORNIA DO not fill in <br /> use of complyWf1h THE RESOURCES AGENCY <br /> local requirements DEPARTMENT OF WATER RESOURCES No. 235937 <br /> ]nice.4 Intent Nn. WATER WELL DRILLERS REPORT stare Well Nn. <br /> L„cal penelt No. or Dare83-8855 _ ..Otth�her Well No <br /> WN . — <br /> ( 1) OWNER: N n,e erpmMIKE RODRIGUES (12) WELL LOC: Total depth 225 Depth of completed well 225 it. <br /> Address 11045 E. Ada Road from fr. to ft. Fnmmtlon (Describe by color, charneter. size or material) <br /> city Stockton, CA - <br /> (2) LOCATION OF WELL (See i,stnictions): <br /> CountyOwner's Well Num _ber p IR Inlay <br /> Well address if different frow above-UM-9. Ada Rd• 8 - 25 sand <br /> Towrahip Range Sectio 25 �s I cla <br /> Distance from cities, roads,reflmads,fences,etc. 1 - 42 sand <br /> 42 - 50 clay <br /> 50 - 5 sand <br /> 5 - clay <br /> (3) TYPE OF WO E12 grave <br /> New Well EX Deepening ❑ 32 - 56 clay <br /> Reconstruction ❑ 00 - grave <br /> Reconditioning ❑ 97 - 107 clay <br /> N <br /> - Flodzontal Well ❑ 107 - 116 sandi <br /> N Desmation ❑ (Describe 116 - rocks <br /> destruction materials and <br /> I procedures in Item 12) 125 - clay <br /> } `I (4) PROPOSED USE: 130 - 152 sand <br /> Domes c <br /> 152 176 gravel <br /> Y <br /> Irrigation ❑ 176 - 192 rocks <br /> Industrial ❑ 192 - 202 cls <br /> Test Wall ❑ 202 - 225 rocks <br /> -- - Stock ❑ - <br /> Mmieipal ❑WELL LOCATION SKETCH .Other ❑ - <br /> (.5) EQUIPMENT: (ll) GRAVEL PACK: - <br /> Rotary ZZ lieverse ❑ Yes [jt No ❑ SizeDes - <br /> caMe Cl Air ❑ Diameter of be H <br /> Other ❑ Rueket ❑ Packedfrom to 77_�__k - <br /> (7) CASING INSTALLED: (8) PERFORATIONS: saw cut <br /> Steel ❑ Plastic a[ Convete ❑ Type of perforation or size of screen - <br /> or ir%emoying of the Seal <br /> From To Dia. Gage or From To slot <br /> ft. ft. in. Wall ft. ft. size - <br /> (9) WELL SEAL: <br /> Was surface sanitary seal previded? Yes 10 No ❑ If yes, to depth_ S.B_ft. - <br /> Were strata sealed against poLLutiort? Yes ❑ No Ek Interest R. - <br /> Method of well. Work start19 Complet 19 <br /> (1(I) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if known This well was drilled tinder cop ioefsdiction and this report ia_mre to the best o/ my <br /> Standing level after well completion ft. knowledge and belief. �'— <br /> (11) WELL TESTS: SIGNED_.. <br /> Was .re 11 lest made? Yes El N. W If yes, by whom? (Well Driller) <br /> Type of test pomp G Railer ❑ Air lit ❑ NAMEIRANK <br /> Depth h, eater at start of test ft. At end of test ff arson, mi, or corpnraeon !"Mad) <br /> Discharge vaVaun after hours Water temperature Address So Se.swltz Read � <br /> Chearical analysis made? Yes ❑ No ElIf yes, by whnm? City Oakdale, rs Zips '9� <br /> Was elechie Ing made? Yes ❑ No ❑ If yes, attach copy to this report License Nn. Date of this taspart <br /> cwR 188 rase. >ne, IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />