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.1 rt <br /> STATE OF CALIFORNIA Do Not Fill In <br /> THE RESOURCES AGENCY <br /> 0833INAL DEPARTMENT OF WATER RESOURCES N2 89035 <br /> File with nWR�Q �I � -�� � ��WATER WELL DRILLERS REPORT Statc Wc' No <br /> Nater e o Sen. l�i'75 Other Well No-!?z 9-4:9: <br /> (i) OWNER• {11) WELL LOG• <br /> Name Total depth It Depth of completed well I. <br /> Address Vormmoat Dorrrfbe by talar,ebereetrr,star q meteriel,end 11furltrrr <br /> it to it <br /> (2) LOCA'T'ION OF WELL: <br /> cewnty Owner s number If any <br /> 0-5 TnD sail— <br /> Township Rae and Seetmn <br /> D12t2ace from tides toad',railroads etc Mt.0 _ <br /> (3) TYPE OF WORK (check) <br /> New Well M Deepening [3 Recondttrontng ❑ Destroying ❑ 42-5-3 May <br /> If destrracuan,derertbevmterral and procedure an Ite-n II <br /> (a) PROPOSED USE (check): (S) EQUIPMENT- 60 Cl am <br /> Domestic ® Industrial ❑ MUIUClpal ❑ Rotary <br /> Irrigation ❑ Test Well ❑ Other❑ Cable ❑ A:i 01 Ay <br /> Other 11 Aa—RA <br /> (6) CASING INSTALLED: 86-9n C1 Ay <br /> STEEL-x OTHER If gravel packed <br /> 91NGLE JO DOUBLE <br /> Gage Diameter <br /> From 10 or of From To <br /> it it Dram 'Vail Bore it it <br /> Sun o1 shoe or well ring Size of Aravele <br /> Deterabe Io.m <br /> (7) PERFORATIONS OR SCREEN: <br /> Type of perforatton or name of screen <br /> Perf Rows <br /> From TO per per Size <br /> ft fr row it to x In <br /> all <br /> (8) CONSTRUCTION: <br /> Was a surface sanaary seal prwsded} Yes No❑ To what depth O it <br /> Were any stats sealed agarnsc po4luttort2 Yes o No if yea note depth of attara <br /> From It to it <br /> Irrom it to it Woee started 8-20 19 ,Completed 19 <br /> Method of teatt. WELL DRILLEWS STATEMENT <br /> (9) WATER LEVELS, This-tell was drilled tinder my jurirdtcfrott and this report Is trite to Ike bett <br /> Depth at which water was fire foond,if known of my knowledge and belief <br /> fr <br /> Standing level before rforatlog tf Ilnown it NAME fiennirt S Bros. Drilling lis. Inc•• <br /> ]ending level atter peciartumix and devela In fe (iscsson,firm or cotponttoo) (Typed or periled) <br /> (10) WELL TESTS: Address P_500 W. Rumble Rd. <br /> Was pump test made? Yes No If yes by whom2 Modesto. Calip• - 95310D <br /> Ida gal frntrt with ft Drawdown after hra SwNrol <br /> Pempera rnre of waist Was a chemical aaalysu mads? Yes❑ No (Well Drifir ,..;L{] L <br /> was eltetri c 105made of well? Yes F-3NoIf Tor attachcopT License No _ 13.L322 ..,nater' - SU a 19-23 <br /> SKETCH LOCATION OF WELL ON REVERSE I c G <br /> SIDE <br /> [7 ';��-;fir �,4 T WR 1813IREV Ott <br /> 9 6A1 1 COa—cr'�, C.ue ;Pc <br /> ` J� 23170-01509 Gal ION Tp IPAD 05P <br />