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t � 77 <br /> ORIGINAL - - - - - - - --- - - � - -57ATE OF CALIFORNIA <br /> -- - - r - -- - - - -- — Do not fill 1. <br /> THE RESOURCES AGENCY <br /> p� <br /> Fele with DWR DEPARTMENT OF WATER RESOURCES NO. 076262 <br /> of Intent No WATER WELL DRILLERS REPORT <br /> Strata Well No <br /> i Permit No or Date $0--1036 other Wall No 03.5, Q,,. LC 2 Q _ <br /> ( 1) OWNER Name JIM MOS t 7� (12) WELL LOG Total depth 100 ft Dapth of completed well 100 f <br /> Address 29 E. Grantline Rd• from ft to ft Formation (Descnbe by color, character sue or material) <br /> (,it) Tracy, CA zip 0 - 2 tOR soa.l <br /> (2) LOQATION OF WELL (See instructions) 2 — 10 clay <br /> County an Joaquin owners Well Number 10 - 25 sand <br /> Well nddress if different from above Koster Rd. Parcel A 2 - 0 clay <br /> ^� 30 35 sand <br />� Township Rang {-, L 7 '--� "' 0 y <br /> Distance from eib roads rnilroads fences etc `5 out Lir �}1j! 0 Lvl F/ <br /> Ferry R 0 - 2 dated & gravel <br /> 2 _ 8, clay <br /> 2 sand <br /> (3) TYPE OF WORK 82 90 <br /> New Nell X Deepening ❑ 90/Z," 96 sand <br /> Reconstruction ❑ 9 = 1,G0 clay <br /> Reconditioning ❑ <br /> Horizontal Well <br /> f] <br /> Destruction ❑ (Describe ♦`� _ - <br /> destruction materials and <br /> -. <br /> procedures in Item 12) 1 <br /> (4) PROPOSED USE��tttt�� - <br /> Domestic <br /> Irrigation ❑ <br /> Industrial ❑ <br /> Test Well ` © <br /> Stock 0- - <br /> Mumcapal D <br /> WELL LOCATION SKETCH Other ❑ - r <br /> {5) EQUIPMENT (6) GRAVEL PACK /.' ' <br /> Rotary 9; Re%erse ❑ Yes [X No ❑ Size <br /> Cable ❑ Air ❑ Diameter of bore 1T s <br /> ' Other ❑ Bucket ❑ Packed from, 5-Q to�_+.,00 t - <br /> (7) CASING INSTALLED (8) PERFORATIONS r - <br /> Steel ❑ Plastic ❑ Coacrete ❑ Type of perforation or size of screen - <br /> ' From To Dia G'tge or From _ ro Slot <br /> ft Y <br /> ft in Wall ft ft size <br /> 0 100 6 160 0 100 screen <br /> (9) WELL SEAL - <br /> W as surface sanitary seal provided' I es CK No ❑ If ves to depth.._..-50—ft - <br /> ' Were strata sealed against pollution' Yes [] No 0 interval ft - <br /> Method of realm Work started- 19 Complete 18 <br /> (10) WATER LEVELS WELL DRILLER'S STATEMENT <br /> Depth of first water, if know ft This well was drilled under my Inrradwtiart and this report is true to the best of mi <br /> StandinR lesel after well completio 16 It knowledge and Irelret <br /> (11) WELL TESTS SICNEll c1q , <br /> Was well test made Yes ❑ No 2; If yes, by whnm� (Well Dr lle <br /> Type of test Pump © Bader ❑ Air lift © NAME_ Henna.n _s Bros . Dml-ling Co. , Inc. <br /> Depth to sinter rat start of test ft At end oftest Ft 52Person firm or coloration) (Typed or printed) <br /> r rge_, gal/min after hours Water temperature Address Pelanda�e Avenue <br /> Modesto California z, b <br /> ..nl analysis made Yes ❑ No X If ver by whom City p <br /> electric log made> Yes 0 No DE If Nes attach copy to this report License No 290813 ate of this r.,., Dec . 23 , 198 <br /> ' DWR tae tRECV a 76) IF ADDITIONAL_ SPACE 1S NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br /> 1 <br />