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1 2 <br /> ORIGINAL STATEC OF CALIFORNIA Do not P in <br /> THE RESOURCES AGENCY <br />�fle with DWR DEPARTMENT OF WATER RESOURCES No. 216168 <br />:0intent No WATER WELL DRl<LLERS REPORT State Well Nro <br /> .1h nit No or Date <br /> y� " ��O��th��erWeII No, <br />'(I) OWNER Nam M 1728 <br /> c C [PI 1 & B (12) WELL LOG Total dept�t Depth of completed we lIL 3 7 ft <br /> Address P 0 Bow 1 78 train ft to ft Formation (Describe by color character size or matenal) <br /> rtv 0- 30 Brown-dense c1 a <br /> (?) LOCATIQN OF WELL (See instructions) 3&- 40 Blue r e e n clay <br /> County San Joaquin Owner s Well Number 6 _5 C 40- 50 Blue r e e.n clay wl sand len s <br /> ell address if different from above =S Sto c k t o n & C h u r c h 5 0- 6 0 B l u e n e e Yi'.0 1 a <br /> o.ynship 11 N -----Range 6 E -seonn b 0- 2 0 8 ' - w sand T e n s <br /> Distance from titre+ mads railroads Fences etc 7 S �\ <br /> 137- 140 Bl u >c� ❑ Claz <br /> (3) TYPE OF WORK - <br /> New Well X] Deepening ❑ v-`� <br /> Reconstruction ❑ - � 4� <br /> Reconditioning ❑ <br /> � L Horizontal Well Well ❑ <br /> Destrucftoa {] (Describe <br /> destruction materials as <br /> procedures in Item 12 <br /> Attached <br /> PROPOSED USE' <br /> See Map Attached Domestic ❑ <br /> Imgation �c�`v. ❑ - <br /> Industrial `�� '� ❑ - <br /> i <br /> Test Well ❑ "- <br /> Stock <br /> � ` <br /> IZ- <br /> WELL LOCATION SKETCH Ij Other M w [25 - =- <br /> 3) EQUIPME'N'T (8) GRAVEL. PACK - - <br /> Rotary $) Reverse ❑ Yes on No ❑ 5, t#3 s a n d - - <br /> able ❑ Air ❑ .Diameter of bare 10 - <br /> ther ❑ Bucket ❑ Paeked`from 1 1 7 to, 13 7 _R_ - <br /> (7) CASING INSTALLED (8) PERFORATIONS_ - <br /> teel ❑ Plastic ® Concrete ❑ Type of perfora�on or size of screen - <br /> From To _ Dia Gage-or Fr?=,,,,, To <br /> ft ft in Wall ft ft - <br />' C 0 134 ~ " t c h 4 0 127 " 134 <br /> (9) WELL SEAL - <br /> rerestrataal <br /> assurface sanitary soul provided? _i_LYee CX No C If yes to dep6-1 -k <br /> ed a stns[ pollution? Yes ❑ No C1 Interval ftt - <br /> hletho I of seals �e M e n t 0 r o U t W ork started- - -- is Complet <br /> (10) WA'T'ER LEVELS WELL L)RILLfR S STATEMENT t�Z <br /> epth of first water, if known ft Ths weII y::d <br /> rir mW rurydictian ural shit reporta [rile to the beat of my <br /> ttaading level after wellcompleu� ft knowledgeti <br /> (11) WELL TESTS SIG-4ED <br /> Was well test made? Yes 0 No [3 if yes by whomi ell Driller) <br /> ype of teat Pump Q Bailer Q &lit lift ❑ NAM <br /> epth to water at start of t+yt H At end of test--------ft (Person. firm or corporation) I Typed or printed) <br /> �36g=Inasn after Imus Water tempera Addrer ,? Yas C, No M If yes. by whom' �a1o Cedt o , CAelecTes © `o rgi If yes. attach copy to this report License No 517406 of tial, .,,.rt4' <br /> wR 1936 irrev 7-749} IF AliPITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM _ „, <br />