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ORIONAL STATE OF CALIFORNIA Do no#fill in <br /> V11hDWR THE RESOURCES AGENCYnp �jDEPARTMENT OF WATER RESOURCES No, L4 afIrltttNo .7 WATER WELL DRILLERS .REPORT State wailrmit No or DutR 2-5 r� dzso <br /> Other Well No,_, <br /> (1) OWNER: Nam Frank Nva rt (1.2) WELL LOG: Total dept,.13 5jt Depth of completed weA-1-3 5 ft <br /> Address 3133 Berry from ft to ft: Formation (Descn%e by calor, character, size or material) <br /> Qty ra c CA p 95 0 ^ <br /> 2) LO AT10 OF LL See instrttciiow) C <br /> lay- <br /> a an t oa > n Owner's well Number 0 ^ 0 --sand <br /> Well address if drfferant from nbov 90 ^ 91 cls <br /> To.vnshlp sr�ngc SectiD 1 -- 105 sand & 4K&, 1 <br /> Distancerora achmuds,ads,railroads,team,etc "Flt Street betWee — G <br /> 6TH & 7TH Streets north side lzu sa <br /> 131 L3X\ c a <br /> (s) TYPE OF WORK: <br /> New Noll Z Deepening 0 <br /> Reconstruction ❑ - <br /> Reconditiaaing p - <br /> Ilorizantal Well [] <br /> Destruction ❑ (Describe — <br /> destructionmaterials <br /> procedure in item I — <br /> (4) PROPOSED - <br /> Domestfc — <br /> Irrigation ❑ <br /> Irrdustnanal Q — <br /> TN <br /> ❑SM ❑ — n <br /> WELL LOCATION S=TCH 'other ❑ — <br /> (5) EQUIPNIENT't (g) GRAY AGA av <br /> "'PIP <br /> Rohrry .0 Reveres 13 No Si <br /> Cahle II Air ❑ I] of Gose l — <br /> Other ❑ Bucket 0 Tt <br /> (7) CASINC INST'ALLEDt (8)VhPX0.RAffdkSk <br /> Steel 0 Plan#lc M Co Typo of p or e of screen ^ <br /> From T N Ca o Fro To <br /> ft ftalI ft , #t / r7�� — <br /> Qleen <br /> (9) WELL SEAL � FF© <br /> was surface sanitary seal provided? Yes M No [3 If yes, to depths — <br /> Were strata sealed against pyl�lution? Yes Qp No - <br /> 14fethod of ses f,IentOY� a Rfork stcrf Cam tcd I9 <br /> (10) WATER LEVELS WELL DRILLEW S STATEMENT- <br /> Depth of first water, If known This wolf was drillsd under my furftdictian and tho report Is true to the best of mtr <br /> Standing levet altar well compk tiarL ft knmWe&e and bAWel <br /> (11) WELL PESTS S10"mm w <br /> Was well test made? Yes 0 No X If yes, by whom? (Well Driller) ' <br /> Type of test Vamp 0 Sailer 0 Air lift 0 IMAM Hennings. B B 1 IL� O <br /> Depth to water tut start of tat ft At and of teat ft 3 2 re b ) ped or printed) <br /> �aal/rola aftor_ Address a ands a Ave e <br /> hnnrx Water tempera � s'ti - <br /> AKI analysis mode? Tex❑ No a If yos, by whom? City Modesto, {' ;y f�J�il 3•' ipT�� <br /> djnas a ectrjo log made? Yea ❑ No If yes, attach copy to this report License N r ato of this repo 11-10^ 2 <br /> WR 166 (REV y lel IF ADDITIONAL SPACE IS NEEDED USE (NEXT CONSECUTIVE,� <br /> tC w <br />