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1 <br /> ` r trrATS OF CALIFORNIA <br /> tOR1GINAL Or THE RESOURCES AGIENCY Do not fill in <br /> Wn,oal <br /> with DWR DEPARTMENT OF WATER RESOI)RCES 28613.3 <br /> WATER WELL DRILLERS REPORT N0. <br /> ce of Intent Na State Well No <br /> Permit No,or Date Other Well NA <br /> 1 OWNER Name C3-t of Trac <br /> { ) (12) WELL LOG Total depth ft Completed depth ft. <br /> Address 560Tracy Blvd. from ft. to €t. Formation(Describe by calor,character,size or material) <br /> City Tracy' —ZIP 860 - 865 BroTin Clav Sticky WSmall Stringers <br /> (2) LOCATION OF WELL (See instructions)a*477, — of Grave <br /> County Owner's Well Number 872 ave ay lagers <br /> Well address if different from above 5 Brown Clay Fl Trace of Grave <br /> Township Range Section 885 —895 Gravel Rocks & Clay To-n7e-119R <br /> Distance from cities,roads,railroads,fences,eta — tr nger <br /> 895 -912 roTm Clatz <br /> 91Z -922 Gray & SanE,0553- Rocim <br /> av roan May <br /> (3) TYPE OF WORK 926— Br E! <br /> New Well © Deepening © 932-95U mm ay Harct Stringers <br /> Reconstruction ❑ r ay Myers <br /> Recondittorting p 964 Bro m Qay WIgravel.Stringers <br /> Horizontal Well ❑ Ifar S <br /> Destruction ❑ (Describe rOT rd Stringers <br /> destruction matenals and Btd\4a--ahy <br /> & e Gravel & Bard <br /> cedures in Item 12) O tr n <br /> (4) PROPOSED US <br /> Domestic 0- " X nductor <br /> Irrigation <4C Pipe Grave Tube <br /> Industrial ❑ 2" oundin be <br /> Test Well ❑ _ 250 out Seal <br /> Munici ❑ — 0 <br /> o er f3( 0 _ X 5/16" Blank Casing <br /> WELL LOCATION SKETCH ibe) 90— " X " Ful Flo .070 <br /> (6) EQUIPMENT <br /> tOlItAVICK. —9J 16X 5/1 " Blank Casin ivath S ERotary ❑ Reverse No I4Cable ❑ Air ❑ o f boreOther © Hucke rom b <br /> (7) "INC INSTALLED (8) PER O TI Q _ <br /> steal ❑ Plastic ❑ Ty a( f onarsizeol <br /> From Ti Gage or T t — <br /> ft <br /> ft <br /> i Wall t size <br /> (9) WELL SEAL <br /> Was surface sanitary seatprovidod? Yes ❑ No ❑ Ifyes,todeptlt ft <br /> Werestratamledagaitsstpollutlon? Yrs ❑ No❑ Interval ft — <br /> I <br /> Method of sealing Work started, 19— Completed 19— <br /> (10) WATER LEVELS WELL DRILLERS STATEMENT <br /> Depth of First water,if known ft <br /> This inns drilled under m jurisdiction and this report is true to the <br /> standing iovclafter well completion ft <br /> best offmy knowledge and belfel <br /> (11) WELL TESTS Signed <br /> Was well test made? Yes ❑ No ❑ if yes,by whom? (Wall Drl ) <br /> PUMP ❑ Railer ❑ Air lift ❑ NAME„ Myers Bros. Well Drl ling, Inc. <br /> doptho".1-water <br /> at start of teal ft At end of test ft (Person,([rm or corpnmtion)(Typedorprinted) <br /> chargo—gal/mm after Iwurs Water temperature Address L9 90 F.. T array W . <br /> Chemical amlysts maria? Yea ❑ No ❑ If yes,by whom? City_— !ford, CAZIP 93230 <br /> Was electric log made Yes ❑ No ❑ If yes,attach copy tothis report License No. 548214 Date of this report 8-16-89 <br /> Own: 1es(REV 12.681 IF ADDITIONAL SPACE 13 NEEDED, USE NEXT CONSECUTIVELY NVMBERED FORM 56 9633s <br />