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ORIGINAL STATE OF CALIFORNIA DO not fIII 11 <br /> THE RESOURCES AGENCY <br />'File with DWR DEPARTMENT OF WATER RESOURCES _ No. 216161 <br /> 0of Intent No WATER WELL DRILLERS REPORT State Well No <br /> Permit No or Derr Other Well No Q <br /> 1(1) OWNER Nam B a x t e r /12 87 1 � WELL LOG Total depth 9 Q it Depth of completed wen ft <br /> Andrei PO B o X 1 7 2 8 ± from fL to ft- Formation (Describe by oulor obaracter size or material) <br />'t �� �5ttc�etor C�I� zap 9520 ! 0 - 30 Dark Brown Dense Clay <br /> (2) LOCATION Ok' WEI L (See instructions) 30 - 35 Dark B 1 u B r e e n , dense clay <br /> County San Joaquin Owner sWell Number OS-5B 35 - 40 Gray s nd , Bluegreen , Dense <br />'W ell address :f different from above S Stockton & Church - clay <br /> \ <br /> Townsbrp ! 1-NRange 5 E Sect:a 40 50 Sand <br /> Distance from cities roads railroads fends etc 50 - 99 D a. U e g r e e n , dense G a y <br /> fib - 87 Sartd � <br />' 87 - 90Dar \\ uegeen , dense c a <br /> (3) TYPE OF WORK <br />' See nap attached New Well IL-C Deepening ❑ {�\\ <br /> Reconstruction ❑ <br /> Reconditioning <br />' <br /> Horizontal Well ❑ �\Destruction ❑ (Describe <br /> destruction materials and <br /> procedures m Item 12,y <br /> (4) PROPOSED US <br />' Domestic <br /> Imgahon +`\\.\ ❑ <br /> Industnal ❑ <br /> S tock\�� Qc \ �� <br /> �% Munstpai\� ❑ <br /> WELL LOCATION SKETCH �\ Other MW <br />[5) EQUIPMENT (B) GRAVEL PACK t - <br /> Rotary t", L Re%ene ❑ Yes M \o ❑' sued 3 - <br /> , <br />'C ihle ❑ A:r ❑ et CT of b., 1 0 <br /> Other © Bucket Q Packed from �4 to--- <br /> (7) <br /> o- -(7) CASING INSTALLER (8) PERFORATIONS;, - <br /> Steel ❑ P125t:c,$,� Canerete ZI Type of perforation or size of screen - <br />' From To Dia Gage-or From '` To Slot <br /> ft ft ' . in Wall ft. ��:� ft <br /> t - <br /> (9) WELL SEAL - � — <br />'Was surface sanitary seal provided" Yes ® No r] If yes to depth f)4 ft <br /> Were strata sealed against pollution' Yes ❑ Vo C7 Interval <br /> ,tethnd of sealrn C e m e R t Grout Work started - 19 Cnmplet 19 <br />,(10) WATER LEVELS WELL DRI ERS STATEMENT �Z <br /> Depth of first water if known R Thu' well of refer m ,umdret,ow and thu report rs tare to the beet of m, <br /> Standing level after well mmplehon ft hnarcledge a be of <br /> (11) WELL TESTS SIGNED <br /> 1A is well tent made" Yea C No M If yrs by whonts (Welt Driller) <br />'Type of test Pump C3Marler C1 Air lift E] NAME [} Inc <br /> Depth to water at start of test -ft At end of t ft (Person, firm or con-nation) (Typed or printed) <br /> /Akage onl/min after _hours Water temperature Address 10556 Petunia LN <br /> ��073 <br /> analysis made? Yes ❑ Na ® IE yes by whom? cityPao C2dro , CA stn <br /> elatnc l"), made? Yes 0 No N If yes attach copy to this report License No, 512406 Date of this repo <br /> 10WR 186 (Rey y yai IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORINT <br />