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STATE OF CALDeORN1A <br /> ORIGINAL TH= RESOURCES AGENCY Do not fill in <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT N0. 257169 <br /> tee of Intent No State Well No. <br /> Z i <br /> ti al Pernid Nu or Ddte Other Well No <br /> (I) OWNER Name Kearney K P F (L) WELL LOC Total depth 65 Ft Completed depth 65 _ft <br /> Address 162 E. A1p1ne AVe• from ft to ft Formation(Describe by color character size or material) <br /> City Stockton <br /> -ZIP 95208 <br /> (2) LOCATION OF WELL (See Instructions) <br /> County San Joaquin Owners Well Number SM-6 D <br /> Well address if different from above — <br /> Townsbip 3N Range 6E 5ecteon 35 — <br /> Distance from cities,roads, railroads,fences,ete <br /> m — <br /> If 51�7 <br /> (3) TYPE OF WORK <br /> New Well 6 Deepening ❑ <br /> Reconstruction ❑ — <br /> See enclosed map Reconditioning ❑ <br /> horizontal Well ❑ <br /> Destruction ❑ (Describe — <br /> destruction materials and pro- <br /> cedures in Item 12) <br /> {4} PROPOSED US <br /> Domestic — <br /> Irrigation <br /> Industrial ❑ <br /> Test Well �� k ❑ n\ r <br /> M <br /> nicaer 1Jl tor"gWELL LOCATION sKETGH be) <br /> {S) EQUIPMENT GRAV�LSL'�ACK *•�� <br /> Rotary © Reverse ❑ Nq Na\O $Iasi42/1-2 <br /> Cable ❑ Air [] et of bore 'L <br /> Other ® buck ed from 42.5\ to 65 <br /> l \ _ <br /> (7) CASING INSTALLED- C j (8) PERI ORATIOM — <br /> steel ❑ Plastic 8 orsize <br /> )+ ors D Gage or of — <br /> ft f i L� Wail \ � �•ft"�` size - <br /> +2.2 6 Z./ Sch40 45 " .020" - <br /> (9) WELL SEAL. <br /> Was surface sanitary seal provided? Yes (R No ❑ If yes to depth 42.5 ft <br /> Were strata sealed a aina pollution? Yes [j N Interval 0-42•5 t <br /> Mahodufsealing tsentonite,-z5jTEement: entoni- Work started 13 Completed 1 <br /> (10) WATER LEVELS WELL DRILLER'S STATELMENT <br /> Depth of first water if known— 49-5 _ ft Thido the <br /> Standing level after well completion 49_S �^ft be-it well was drifted under my Jurisdiction and this report li trlr2 <br /> best of my knowledge and [e <br /> (11) WELL TESTS Signed r <br /> Was well test made? Yes ❑ No ❑ If ves,by whom? I (We ler) <br /> of tat /- ��e <br /> Ype Pomp ❑ Bider © Air Isft ❑ NAME LXJiL-�. <br /> V%,e0 water at start of teal ft At end of test ft, finis, rpom Typed or prmteO <br /> rrge gal/min after hours Water temperature Addr <br /> i-121,99 i , - <br /> (,nemtcal analyse made Yes No © if ves,by whom City ZIP <br /> Was electric made Yes ❑ No ye; ropy report Lictrtse Na Date of this report <br /> I If attach to this <br /> OWR 186 iRSV 124ee) IF ADDITIONAL SPACE iS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM 86 96M <br />