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- 3 <br /> STAT e150'e*fffrO►s N 1 A <br />�lle with GWR THE RESOURCES AGENCY Do not fiU it <br /> DEPARTMENT OF WATER RESOURCES No. 216088 <br /> f Iatcat No WATER WELL DRILLERS REPORT <br /> t State Well No <br /> erinet No qr Datc <br /> Other Well N <br /> I) OWNER Nam (I2) WELL LOG4 0 <br /> Address_ 22-22-0 Powe 1 ). S t Total depth Ft Depth of completed well 3 7 Ft <br /> from Ft to ft Formarion <br /> ity Emeva. 11e CA 9 {Describe by color character size or material) <br /> = r <br /> A�08 0 - f0 Fine sand <br /> 2} LOCATION OF WEU (See instruction,) ] 0 - 25 B r o w n c l a y <br /> County San .7oa uln Owners Well Number OS 4A 25 40 Sand & Clay <br />[A-nship <br /> ell iddress if di ferent from bove 0 f£ S o n o r a S t , Stockton I N 6 <br /> Range Section_ - <br /> Distance from cities roads rallmads fences etc <br /> IN - <br /> (3) TYPE OF WORK <br /> New Well Deepening ❑ <br /> Reconstruction Q <br /> Reconditioning Q - - <br /> Horizontal Well ❑ <br /> Destruction ❑ (Describe \` <br /> destruction materials and-i <br /> See Map Procedures la Item 1.2) e' <br />' attached (4) PROPOSED USE _ <br /> Domestic ❑ <br /> Irrigation ❑ <br /> Industria] 0 = - <br /> Te;C Well � <br /> Stock' - <br /> n <br /> 14unicipal` C _ - <br /> WELL LOCATION SKETCH othM o n i t o r i n g a _ _ <br /> EQLIPMEVT {fi) CFtAVEL PACK r <br />"ta'y Reverse C) Yes$n{ No 0 Sez1e 20 _ Y <br /> le ❑ Aar 0 Diameter of bore 1 0 n <br /> er 0 Bucket ❑ Packed from 2 3 <br /> to___3 7 Fr <br /> l} CASING INSTALLED - (8) PERFORATIONS - <br /> [Q Plastic ❑ Concrete 7. Type of perforation or size of screen _- <br /> rom To Dia Gage-or From To SEot — <br /> ft ft fn Wall ft ft s ze <br /> 0 37 4 " 250 27 <br /> WELL SEAL _ <br /> turface sanitary real Provided" Yes7Q{ NO n If yes to depth---2-3-_g _ <br /> strata seated against pollupon' Yes ❑ No Q Intcrva <br /> thud of sealAn <br /> WATER LEVELS I _ work start I9 Complet 1 <br /> of first Water if know * ���+ 1� };+• WXrJ, DRILLER'S STATEMENT <br /> Ing level after well completio well teas dnl insd <br /> d under my nt nd this Orr Lit true to the fest o) my <br /> �i ft Icnrare7edee an of i <br /> I) WELL TESTS <br /> a well test made3 Yes Q NOXX If yes by <br />�of test Pump 0 Bailer ❑ Air Iift0 `' Dal <br /> l <br /> 1 (Well Drell r) <br /> m water at start of tes�{t Ar end of tilt �M nond re Dr inz . Inc <br /> J,— I ( or c.. <br /> - t )0� Qa ^A mnrahonJ {Typed or printed} <br /> al/min after �rours W�Mknip Ad �; �J is o ♦r e t u n 1 a 1,a n e <br /> 11 sis made? Yea Q No_C If yes by whom? `` '?' _ C ~ I Palo �'.e d C O , CA 96073 <br /> n <br /> log made? Yd 0 No-' If}es attach cnPy'U�thia reQort s•�• I.ii�me Nn_ 2 4 0 6 n1 -04- 89 <br /> _. ate of this repo <br /> ISa tncv z lel IF ADDITIONAL SPACE IS NEE4__5 CONSECUTIVELY NUMBERED FORM <br /> 3 <br />