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STATE OF CALIFORNIA �... Do Not Fill In
<br /> THE RESOURCES AGENCY
<br /> ORIGINAL DEPARTMENT OF WATER RESOURCES W 'A � �'``94553
<br /> �1 4 5 5 3
<br /> Fits With DWR State Vcrell No.W �E^SN`
<br /> WATER WELL DRILLERS REPORT c H
<br /> Other Well No/ b
<br /> (1) OWNER: (11) WELL LOG:
<br /> Name State o f California Toml dep,h f,. Dep,h of completed well 315 ft.
<br /> Address Formation: Dnrribr by colo+,rba+ortrr,si:r of material,and tt+> I...
<br /> f,to rt.
<br /> (2) LOCATION OF WELL: 0 25 Yellow Flay
<br /> County 5 a Joaquin Owner's number.if any
<br /> Township,Range,and Section
<br /> Uuunce from—irs,roads,railroads,etc.
<br /> 128 137 Rlup f-l ;;y
<br /> Plymouth & Country Club 137 147 Sand
<br /> (3) TYPE OF WORK (check): 147 160 RJUR rl AV
<br /> New Well RI Deepening ❑ Reconditioning ❑ Destroying ❑
<br /> I/destruction,Jescribe malerial and procedure in Item 11. 162 170 Rlup f-1 RV
<br /> (4) PROPOSED USE (check): (S) EQUIPMENT: 170 180 Sanri
<br /> Domestic ❑ Industrial ❑ Municipal ❑ Rotary
<br /> Irrigation ® Test Well ❑ Other ❑ Cable ❑ 235 252 Sand & Gravel
<br /> Other ❑
<br /> (6) CASING INSTALLED:
<br /> STEEL: OTHER: If gravel packed
<br /> SINGLE Ej DOUBLE ❑
<br /> 313 315
<br /> Gage Diameter Blue Clay
<br /> Froin I u or of From To
<br /> ft. It. Diam. Wall Bore ft. ft.
<br /> ±1 5 2 B
<br /> 0 315
<br /> plate s;,,of
<br /> Ue, robe wi
<br /> (7) PERFORATIONS OR SCREEN:
<br /> r,pe i prrlenunn atname ar,rrern
<br /> Louvered &. F u l—f t o
<br /> Perf. Rows
<br /> Pruni To per per Size
<br /> ft. ft. row ft. in.x in.
<br /> 2�9 253
<br /> 97 -
<br /> (s) CONSTRUCTION:
<br /> w'„, urlara 1111-1y,eat p,—ded? Y , — No To what dep,h 50 ft.
<br /> u err an , ,,led axalnst pullo,—? Ye, ❑ No (X If vee,nate depth of,tnta
<br /> tram ft.
<br /> h. v:'nrk --J 19 ,Completed 19
<br /> ase,had of,e,i.nr WELL DRILLER'S STATEMENT:
<br /> 9 WATER LEVELS This well uas drilled under my jurisdiction and this report is ir-ne io the best
<br /> ( ) of my knoudedgr and belita.
<br /> Urpth a, whrh ,er aas fint fo—d, .f kno>n f,.
<br /> �:andlnx Ie,.l b.f„re perfor—ng, .f kn r,. NAME Clark Well & Equipment Co.
<br /> )ending level after p,rfon,ing and d,yeloping ft_ (tenon,firm,or wpontlon) (T)'p,d ar pr]r,trd)
<br /> (10) WELL TESTS: Address 2024 East Charter Way
<br /> wa,pomp ,ad,? Yes X N'o ❑ ,f,ea,d,y w hom? P G &. E Stockton CA 95206
<br /> J�
<br /> 820 wlth 40 9 f,.drawdown after hn (SIGNED] / •! �- -
<br /> �/ 1V'rfl UrA(r+1
<br /> -I—per ..f water V'a,a chemical analyse mad,? Y'es EX E)No
<br /> V'a ,I,ctr,c I,.g mad,of well? l'„k No.n If v,,,anach ropy Liccnse No. 76602 _Dated
<br /> SKETCH LOCATION OF WELL ON REVERSE SIDE
<br /> DWR 188 .FEV 9-6st 35,]9-9lO 9-61t 50M TRIP Qp OSI
<br />
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