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ORIGINAL SrAYFS OF CALIFORNIA DO not fill in <br /> THE RESOURCES AGENCY p� <br /> 'le with DWR DEPARTMENT OF WATER RESOURCES N0. 145772 <br /> of]stent No� WATER WELL DRILLERS REPORT State well No <br /> amilt No.or Date <br /> --^ Other <br /> (1) OWNER- Ham Don Cole (12) WELL LOG- Total dept1L22O.ft Depth of completed welt 1.22 it <br /> Add P a 0• BOX 32 from ft. to it Formation (Desenbe by color. charnater, size or mnterial) <br /> City Trac CA. Zr 0 -20 Clay <br /> (2) LOCATION OF WELL (See instructions) 20-27 Gravel <br /> County Owner's Well Number 27 -35 Cla <br /> Wall address if"Orent from abo 35 -45 an <br /> Township p"n45 -8 actin w <br /> Distance from cities.roads,railroads,fences,ate—On Schulte Rd• ve <br /> est of MacArthur -Rd. 60 Clay <br /> Gravel <br /> 70 :74 Cls <br /> (3) TYPE OF WORK Gravel <br /> New `Nall 9 Deepening 0 Clay <br /> Recorutraction ❑ 10 3 Gravel <br /> Reconditioning 11 2 Cla <br /> Horizontal Well ❑ Gravel <br /> Destruction a (Describe 3 Ql <br /> destruction materials apa <br /> procedures in Item ], 'a <br /> (4) PROPOSED1'74 l <br /> Domestic 212 ra e <br /> Irrigation g <br /> industrial ❑ <br /> wev ❑ <br /> str - <br /> Munlcip <br /> WELL LOCATION SKETCfI Other [] <br /> (5) EQUIPMENT (B) GRA PACKS <br /> Rotary l3_IPReverse ❑ No S 8 <br /> Cable 0 Air ❑C i r of bore ll= — <br /> Other ❑ Bucket Q a79 122 <br /> 11 <br /> (7) CASING INSTALL El7 (8) RFORA Sr <br /> Steal ❑ Plastre$} C t Type of p i or si: 0dt!Y t From To Df a ll r F a� To <br /> ft f to Wall f ft Q <br /> 0 1 1 ow 12v 122 - <br /> (9) WELL SEAL - <br /> Was surface sanitary seal provided? Yes L7_x No 0 If yes, to depth_�50ft — <br /> Were strata seated against ollutran? Y ❑ No 0 Interval ,ft <br /> Mothad of Sealing- �enton�te <br /> Work start — I9 Complete 14 <br /> (10) 1IVATER LEVELS WELL DRILLER'S STATEMENT <br /> Depth of first water, if know ,Ft This well was drilled under my fnrisdfalon and this report is true to the best of rap <br /> Standing level niter wall completion ft, knowledge and bellaj <br /> (11) WELL TESTS Sic <br /> Was well test made? Yes Q NnM If yes, by whom? (Well Driller) <br /> Type of test Pump 0 Bailer p Air lift 0 NAM �a s Bros, DrillIng Co* , Inc <br /> Depth to water at start of test ft At end of test - ttarson,Arm, or cc ration) (Typed or printed) <br /> n e d^Vmin after—_______hours Water temperature Ac}drr�s 352 Pelandane Ave. T „ <br /> analysis made? Yes C] No�] If yos, by whom? J Cajts� Modes tin L CA.• �p Q <br /> oleetrfc laq made2 Yos [] Ne Q[ IF ser, attach copy to this sopor- J.icense No ata of this repos <br /> t7WR 168 (REV 7 gal IF ADDIT1ONAL.SPACE'IS NEEDED %JSP NEXT CQNSECUTIVELY NUMBERED FORM <br />