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7 <br /> STATra OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill in <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT N0. 2 5 6 A. 9 3 <br /> l ce of Intent Na State Well No. _ <br /> ]Permit No or Dnte '0Other Well Na L'0504;AE a <br /> (1) OWNER Name Namo n others (12) WELL LOG Total depth 08 ft Completed depth fL <br /> Address 1624E Portoiafrom ft. to ft. Formation(Describe by color,character,size or material) <br /> City Tracy. CalifO ] 7IP <br /> (2) LOCATION OF WELL(See instructions) <br /> County--- San joaCLuln Owners Well Number <br /> Well address if different from above <br /> Township Range 06 Section <br /> Distance from cities,mads,railroads,fences,etc. <br /> Southib i <br /> (3) TYPE, OF WORK, <br /> _NetirNMX] Deepening ❑ <br /> Reconstrucklon ❑ <br /> Reconditioning ❑ <br /> Horizontal Well ❑ <br /> Destruction t1 „(Describe <br /> destruction materials and pro- <br /> --�•� cedures In Item E2) <br /> (4) P11OPOSED US _ <br /> Domestic <br /> 1 Irrigation _ <br /> ( Industrial ❑ <br /> Test Well ❑ <br /> Mumcl © _ 0 <br /> WELL LOCATION SKETCH < tbe) <br /> (5) EQUIPMENT GRA V t� CIG <br /> Rotary ❑ Reverse ❑ Ne i <br /> Cable ❑ Air C3O bore <br /> Other ❑ Built rom — <br /> (7) CASING INSTALLED {8) D Q <br /> Steei ❑ Plastic ❑ Ty of fa on or s[u — <br /> From Gage or t <br /> €t f Wall t size <br /> (9) WELL SEAL - <br /> Was surface sanitaryseal provided? Yes ❑ No ❑ If yes,to depth ft <br /> Were strata sealed against pollution? Yes❑ No❑ Interval ft — <br /> Method of sealing Work started 19___.._. Complet 19 <br /> (10) WATER LEVELS WELL DRILLER'S STATEMENT <br /> Depth of first water,if known ft. <br /> DepthStandif first <br /> after if knowll pletian ft. This welt teas d ed u m f urt tr ton and this report is true to the <br /> best of mV knoe g2 !t <br /> (11) WELL TESTS Signed <br /> Was well test made? Yes 0 No❑ If yes,by whom? W ) <br /> Ak.efts=, pump 17 Bailer [3 Air C] NAME _Clark well EQUI.pment Co. , Ing.to water at start of test ft At end of lest ft � ` <br /> bargePI/Min.after hous Water temperature Address 202EF� rre: a <br /> rimed) <br /> Ca��.ft]rnia <br /> Chemical analysis made? Yes ❑ No-0 IfM by whom? OCOrif ZIP } 20 <br /> aty 5 <br /> Was eleetric log made Yes ❑ No ❑ If yes,attach copy tothitreport License No 3 Date of this mvort <br /> DWR tat?IRBV 12.88) IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM 04 9035 <br />