Laserfiche WebLink
ORIGINAL � srA-rt of ci+uFoarvtn Do not#11 tr <br /> THE RESOURCES AGENCY <br /> File with DWR DEPARTMENT OF WATER RESOURCES No. 076263 <br /> ,if Intent Nn WATER WELL DRILLERS REPORT state Well ,iso,10 7 <br /> rl Permit No or DBte_` o-103 J _ Other Well lin -V A-'; <br /> ( 1) OWNER u,mr J1M MOS t 7� (12) WELL LOG Total depth 1001t Depth of completed nelL..,J,_0 ft <br /> Address 29 7 E• Grantline Rd. from ft to k Formation (Describe by color, char-icter size or material l <br /> C.rty racy zip95776- 0 - top 305.1 <br />' (2) L�CATWN OF WELL (See instructions) — clay <br /> Cottnty an Oa uin v pursers well Number D C� ry2] sand ravel <br /> Wdl address if different from ahove Koster Rd. , Parcel $ 52 ( + clay <br /> To.snshrr 1 ,' � _ sin grave <br /> I Mange ,.., sectio �+ <br /> Distance from cities roads ratlmids femes etc 2 O south ei cic3 <br /> Durham Ferry Rd. - 8 sand & gravel <br /> 9 T100 clay <br /> (3) TYPE OF WORK <br /> New Well Qt Deepening ❑ - <br /> Reconstruction ❑ _ <br /> Reconditioning ❑ <br /> Horizontal «ell ❑ <br /> Destruction ❑ (Describe r <br /> destruction n,ntenals and <br /> pr(xedures to Item 12) <br /> (4) PROPOSED USE - <br /> ' Dnmeshc g[ _ <br /> Imitation <br /> Industn A ❑ - <br /> Test Well [] - <br /> Stock ❑ - <br /> Municipal ❑ <br /> WELL LOCATION SKETCH Other <br /> 1 (S) EQUIPMENT (B) GRAVEL PACK T <br /> Rotary Z Heverse ❑ Yes Z1 No ❑ Size b-i-rds Giza <br /> Il <br /> C rhle Q Air ❑ Diameter of bore - <br /> ' Other © Bucket ❑ Packed fromtn�©,�_�ft = <br /> (7) CASING INSTALLED (8) PERFORATIONS <br /> Steel F-1Plastic ❑ Concrete ❑ Type of perforation or size of screen - - <br /> I From To Dia Gage or From - To Slot <br /> ft ft In Wall ft ft size <br /> 0 100 160 $0 100 screen <br /> (9) WELL SEAL <br /> Was surface sanitary seat provided" Yes JZ No ❑ If yes to depth ..... It - <br /> ' Were strati sealed against pollution' Yes f❑ No ❑ Interval It - <br /> Method of sea1mg Cement Work started 19 Completed 19 <br /> (10) WATER LEVELS WELL DRILLERS STATEMENT <br /> Depth of first water of knoll It This well cies drilled under nub rrrrisdictron and this report is true ra the besr of nib <br /> ` <br /> Standing level after well completion If knowledge and beliefnn ��� <br /> (11) WELL TESTS SIC%ED— - - <br /> Wns well test made? Yes ❑ No:N If ves, by svhumv (Well Dri r <br /> Tope of test Pump (] Ballet ❑ Air lift ❑ NAME Hennings Bros. Drilling Co. , _Inc. <br /> Dcptb to ,eater at stnrt of test It At end of test ft (Person firm or corporation) (Typed or printed) <br /> lge gal/nun after hours Nk iter temperature Address 3 52 5 Pe la ndal e Avenue G L <br /> ical anm <br /> flysis adeP Yes ❑ No If yes by whom? City Modesto j Call �__ <br /> forni - }U <br /> Q � zip <br /> electnc loF, m-ide7 Ies ❑ No If%es attach copv to this report License No ^2l T1ate of this report Dec 23 1 V <br /> PWR 188 (REV 7 7e1 IF ADDITIONAL. SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />