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STATE OF CALIFORNIA Do Not Fill In <br /> THE RESOURCES AGENCY �r <br /> ORIGINAL DEPARTMENT OF WATER RESOURCES !� O 91554 <br /> File with DWR <br /> WATER WELL DRILLERS REPORT St]te Well No.�� ��_ � �� <br /> Other Well No <br /> ( a OWNER: <br /> Name (I I) WELL LOG: <br /> _ Stata of Ca )_j,f❑rnia ro[alJt,t? <br /> fc. per[h of_comrlr[cd wdl 273 ft, <br /> Address Pormzsion: Drscribr by rolor,cli—cfer,size of material,and strurlurr !I <br /> fr.to ft. <br /> (2) LOCATION OF WELL: 0 175 C1ay_ <br /> f, l.ounsv S c-(n _ �_ wner' <br /> Os n mIc .if a 5 20 <br /> Tawnshi R Sand <br /> r ange,and Section 20 i3 cla `i <br /> ➢;ranee frorx cities,roads,railroads, - ❑C L 5 an d <br /> n1 ,en Rv� R. _j 67 1133 Clay <br /> (3) TYPE OF WORK (cbecla): 13 3 141 Sand <br /> New\Voll Deepening [] Reconditioning ❑ Destroying ❑ 14 16 2 C 1 @-N! d <br /> /I destruction,describe inalerial and¢rorrdurr in lic?, 11. <br /> 1.69 179 Sand <br /> (4) PROPOSED USE (check): (s) EQUIPMENT: ::'1 205 C1a <br /> Domestic ❑ Industria€ ❑ Municipal ❑ Rosary ® 205 272 Sand & $il <br /> SI..__..._r a v e <br /> L Irrigation (� Test Well ❑ Other EJ Cable El2 2 280 Cla G <br /> _ Other ❑ — <br /> (6) CASING INS'T'ALLED: I � <br /> STEEL: OTHER: If gravel packed t <br /> SINGLE: K DOUBLE I <br /> Ga_qe DiMCTCr <br /> From I'o or of From To <br /> I ft. {t. Dian'. Will Bore ft. ft. r <br /> �s _50k <br /> 12 180 20 <br /> Y' Size of shoe er well r 1f 4 plate <br /> �a Siae of zero scl: <br /> Fr=ti r <br /> Describe i,inr W el <br /> (7) PERFORATIONS OR SCREEN: <br />�- 1 ypc of p�-rtar=inn ar n of screen `• o <br /> l <br /> i <br /> Perf. Rows _ <br /> From To per per Size F <br /> fit. row fr. in.x in. <br /> 25.5r <br /> --ZS 5 2.7 3t <br /> (S) CONSTRUCTION: j <br /> 1t'+,a surface uairxry seal provided? YrsX� No ❑ To who dcp[h 50 f[. <br /> I <br /> Wrr uu.ealed ogsinsr poliutinn? Ycs[] No If yes,note depth of saau <br /> From 3 (r- to ft. <br /> From ft. m ft. }Work starred 19 ,C6mp1c[ed2 1 J u '7 19 r 2 <br /> Me[hod of, h.g WELL DRILLER'S STATEMENT: <br /> of my knowledgr and belief. <br /> (9) WATER LEVELS: chis well was drilled rinder my 11irisdictior and lbirL vrporl is torr to the brst <br /> Depth ac which wooer was firs[ found, if known ([. <br /> Standing level before perlora[inR, if known {c. NAME Clark Well & E ui ment Co i <br /> i[xndinR level after perforatine and developinG ft. (Parson,firm,or eorporttionj (Typed or primed) 1 <br /> l (10) WELL TESTS: Address 2024 East Charter Way _ <br /> l far pump re madr> Ytr moo Ir res,6y whom? P G $ E <br /> Stockton , CA 95206 r <br /> ���� ¢sl.fmin.with ft.Drawdown a([er hes. [SIGNED] : l <br /> x_m pera mre of w.+rer 'as+chem cal analysis made? Yes AL1 No ❑ <br /> W'a clrctric'lar made of xdl? Yrs No © if ,arch ory ell➢u2llr4r) J V1ViCCnSe o. 77LL DsLC( 197=2— <br /> } <br /> i <br /> SKETCH LOCATION OF WELL ON REVERSE SfDE l <br /> I <br /> �y QWR 1123 IFEV. 960i <br /> ]5�]9-350 r_se 5�4 TPIP AD OSP "; <br /> I 1 <br />