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)RIGINAL STATE OF CA4IFORNIA Do not fill t:n <br /> THE RESOURCES AGENCY <br /> IEe with DWR DEPARTMENT OF WATER RESOURCES NO. 071438 <br /> Ontent No WATER WELL DRILLERS REPORT Strte M ell No _ _ <br /> iit No or Date ��Othhe((r %%ell No S�2 62: 2,L J <br /> 1 I OWNER ,tmc Bob Hall_ (12) WELL LOC Tnt it depthft Depth of completed µell 95 ft <br /> duress 21+ W. Erjae rs u n Avenue from ft to ft Formation i Deccnbe bs color character size or m iteral) <br /> it, Tracy, CA 1-tp 537 0 - top 30a.1 <br />? LO ATION OF WELL - 1 clay <br />"I nt� a-12-10a u2 n {See instructions) 1 - 2 sand , <br /> Owner s 11 ell Number <br /> r11 address If different from abo}e 24 4 clay <br /> «nshtp R-inf,e Sector 46 — ra v e <br /> ._. <br /> ristance from cities roads rlilro-idc fences etc Old hi,-,hwax 50 - Gla <br /> 8001 west of Chrisman next to Hart 65 - 73 grayel <br /> Jlectric 73 - 80 c ay <br /> 80 90 sand <br /> (3) TYPE OF WORK 20 - 150 clay <br /> Neu \'tell W Deepening ❑ �♦ <br /> Reconstruction ❑ — <br /> Heurnditwmnf, ❑ — <br /> Horizontal ll ell ❑ — <br /> Destruction ❑ (Descnbe — <br /> destruction mitenals and <br /> procedures in Item 12) — <br /> (4) PROPOSED USE - <br /> Domestic — <br /> Irng,ttion Cl - <br /> Industrial 0 — <br /> . Test Well ❑ — <br /> Stock ❑ <br /> Municipal ❑ — <br /> "ELL LOCATION SKETCH Other 0 — <br /> S 1 E¢UIPNIENT (6) GRAVEL PACK — <br /> otin [Ir Reserw ❑ les CY ,o ❑ s.,.B1.rdseye _ <br /> tole ❑ Air [] Diameter of bore 11 tt — <br /> ther D Rucket ❑ Pached from--5-0—,,o-2L--ft - <br /> CASING INSTALLFD (8) PERFORATIONS - <br /> teel ❑ Plistic 0 Concrete ❑` Tipe of perforation or size of screen — <br /> From To Dia Gale or From _ To Slot - <br /> ft ft to Wall ftp ft s.ze - <br /> 0 95 60 65 70 Green <br /> 9) WELL SEAL - <br /> - +urfa(c sinttan sett proirdcd� les ]?" ,o G If see to depth 50 ft — <br /> 1 err +trita sealed tr,unst pollution' 1c C] No L, Inten 11 ft — <br /> Itchod of sethn dement llorl, started rcl 19 Coinplcted 19 <br /> 10) WATER LEVELS AVELL DRILLERS STATEMENT <br /> lepth of first water if kmsµ R This well tvas drilled tinder my turesdictrun and this ry+Urt is retic to tht last 44 mtr <br /> tanding level after µell corupletiort_ _ft knowledgrind bj <br /> eh ,{ , <br /> 11) WELL TESTS Src%�a 'u-/ <br /> t µell tett midi' les ❑ No Lu- If +es b+ µhomy <br /> (NN ell Driller) <br />.pe of test lluntp ❑ 13ulcr CD Air lift 0 NALMF . Henngn s _bros_o Dr2-112ng Coos Inc. <br /> it pth to µttcr -o st in of test ft At tnd of tcst ft er n mt or coTortUop) (Tvpec] or printed) <br /> ANIL al/rrun after hours %%atcr temperature Address 352 + etndc .Le ftvenue <br /> Ctt% Modesto California zep�95 356 <br /> anil3sis made les (] No [elf ses by whom }7 ��-}} <br /> VS electnc lot; made, les © No LW 1f ses attach tops to this report License No. 290813 Date of this repo NJarch 2 1 O( <br />)WR 188 1REV 7 76) IF ADDITIONAL_ SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />