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1 i <br /> ORIGINAL STATE OF CALIFORNIA Do not fiU it <br />'F' with DWR THE RESOURCES AGENCY <br /> DEPARTMENT OF WATER RESOURCES No. 216102 <br /> of Intent No WATER WELL DRILLERS REPORT State well No <br /> Pernut No or Date Other Well No <br /> ( 1) OWNER Nam 12 2 4 6 <br /> l � WELL LOG Total depth______�ft Depth of completed we1l_____.,.It <br />'Addres P B o X 1728 from ft. to ft Formation (Desenbe by color character size or material) <br /> C,ty Stockton Ca zip 252Q1 0 - Dark Brown Dense C <br /> (2) LOCATION OF WELL (See tnstruetlom) 32 -75 B1 ueC <br /> lay <br />'County Owner s Well Numbe - tt 7 -9Q S --& <br /> Well address if different from above S S 90 -145 Sand , C 4b e e- Some Clay <br /> T,,,vnchip 11 N Range 6 E Sectio 145 -183 C i aDark Z. n a e Blue <br /> Distance from tides roads, railmads fences etc 183 -224 S a m 4-& Grave 1 -C 1 a <br />' 224 _246 Sand,'& Grav <br />' (3) TYPE OF WORK <br /> New Well C Deeperung ❑ <br /> Reconstruction ❑ <br />' Recondrtsoning ❑ \� - <br /> Honzontal Well ❑ - <br /> Destruction ® (Describe <br /> destruction materials annd <br /> procedures m Item 1-y)' <br />' (4) PROPOSED 'LJSE- _ ' �� 7, <br /> Domestic {� / <br /> .� <br /> Irrigation ` [] - <br /> See Map Attached Industrial ❑ �- <br /> Tese Well ❑ <br /> Stock\\ \ \ls <br /> Munrcrpal <br /> WILL LOCATION SKETCH 1 er ❑ <br /> (5) EQC,IPtiIENT (6) GRAVEL PACK - - <br /> Rotary in Reverse ❑ 'Yes ❑ No 0-' Sue <br /> 6 " <br /> Cable ✓r] Au ❑ I)�i@meter of <br /> Other ® Bucket Q Packed from to� <br /> (7 t CASING INSTALLED , '�' \ (S) PERFORATIONS - <br />'Steel ❑ Plastic ❑ Concrete Type Type of perforsitlogor sbe of screen <br /> From To Dia Gag`w FroTo !r sioc% <br /> ft ft hi Wall ft .\. ft "'Sze'- <br /> (9) <br /> 'Sze'-(9) WELL SEAL <br /> Was surface sanitary seal provided" Yes g( No ❑ If yes, to depth- 2 4-6 ft <br /> Were strata sealedrrttt pollution" Yes ❑ No ❑ Intery <br /> T" <br /> Method of seafur �e m e n t Grout Work s 2-21 1= Complet 19 <br />'(14) WATER LEVELS WELL DRI ERS STATEMENT <br /> Depth of first water if known �- Thu urall war �rder m purudictron and this report ra true to the beat o/ m. <br /> Standing level after well complett knawledQs a be of <br /> t 11) WELL TESTS SIGNED <br />'Was well test made" Yes ❑ No (9 If yes by whnm? (Weis p'Zlk*77 <br /> Type of test pump 0 Battler ❑ Au [rfe ❑ �)pl�, it O n d Car D r, 1 1 1 n q l n C <br /> D to Water at start of teat K ALt end of test ft (Peron, firm or corporation) (Typed or printed) <br /> Add.. 10556 Petunia LN <br /> e .$al/min after hours Waxer tempera Palo C e d r o , CA Z,p 4- 1.3-�9 <br /> 1 analysis made? Yes 0'� No ® If yes by whom? Csty <br /> Date of this repo** <br /> electric log made? Yes ® No ❑ If yes attach copy to this report Lscense Ho. - <br /> OWR tae (Rev 7a1 IF ADDITIONAL SPACE 15 NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />