Laserfiche WebLink
r <br /> STAT!OF CALIFORNIA r ' <br /> - THE FESOURCE3 AGENCY UO not fill in <br /> ORIGINALDEPARTMEiVT OF WATER RESOURCES <br /> File with DWR WATER WELL DRILLERS REPOT?'T N0. 290676 <br /> v: <br /> 5to:e Well Na <br /> ,.Notice of Intent No. 8$-3126 Other Well No, <br /> Local Permit Na or Date <br /> (1) OWNER; Nume, �T ' �Se (12) "'ELL LOG: Total depth,inn ft.Completed depth�5—.ft. <br /> Address 25516 S. Banta Rd, from ft. to rt. Formation iDescribe by color,charaMer,sitz or material) <br /> City Tracy, . _zrP 95376 <br /> ¢ - 30. rravel and rock <br /> (2) LOCATION OF WELL(See instructions): <br /> County _Sc-M Joaeftj�ri owner's Well Number — <br /> 72 clay st <br /> Well address if different from above 75 <br /> amml and rack <br /> Townshi TzaCV _Range.� $cellon <br /> :,,•: '-'Distance From cities,roads,railroads,fences,etc. — <br /> 5J TY OF WOi;K: <br /> PE <br /> — N <br /> _ <br /> � <br /> New Well XX Deepening <br /> Reconstruction ❑ <br /> Reconditioning ❑ <br /> Horizontal Well ❑ <br /> Destruction ❑ (Describe <br /> destruction materials and pro- <br /> cedures Item 12 <br /> in ) <br /> (4) PROPOSED US — <br /> Domestic Pra V — <br /> i Irrigation <br /> f Industrial O ❑ — <br /> Test Well Cl <br /> Munici ) ❑ — <br /> I O er <br /> WELL LOCATION SKETCH be) <br /> (S) EQUIPMENT: GRAv CK <br /> �., <br /> Rotary ®. Reverse 13 No <br /> Iz <br /> F bore <br /> xa Caw ❑ Air ❑ et — <br /> m k � <br /> Other. ❑ <br /> 6nc <br /> ° (7).0 CASING INSTALLEi?.. (e) PER Tr Q — <br /> ;r,4 - ':. Plastfe ❑ - Ty of. E on or size Of <br /> h', ;'Steel ❑ <br /> From '•T i Gage or T t — <br /> ft: F i Wall t size <br /> 10 160 <br /> FIVIC <br /> (9)._WELL:>SEAL:. <br /> Was surtaoe mnllary-eel provided? Yes K) No[] If yes,to depth <br /> wY' Interval rL — <br /> �' Were atrsta,nledagalnst pollutien7 Yes❑ No — 19 <br /> Work started 18-.— <br /> s <br /> Com eted <br /> r� �i�tet3�ad or>tilint WELL DRILLEII'S STATEMENT: .. <br /> H ` n <br /> (IO} ER:LEVELS: <br /> Depths rstwater.ifknown Et Th welt u drilled under m jurisdiction and Ihfs report is Ime to the <br /> handingieJ41after well completion ft jxstofm ko_w[edgeandbrllrJ. +Q <br /> (11) W <br /> signed&4k <br /> ELL TESTS: <br /> . r2tir.�ltf�Pk1m_ r-- — <br /> - � Well rt ell <br /> Wei well test made? Yes ❑ No!� If yes,by whom? lir Tilt ❑ NAME Calwater Drilling - <br /> Pnm ❑ hailer ❑ <br /> 'Type of tot P At end n<tat f I £r .firm,or rnrperasson fTyprJ or printedl <br /> ' Depth townterslstsnofkrot - ft Address 300 $- It'l�x <br /> ¢i�ahs a 6allminafter hour wslrrtemperature zip g53B�— <br /> f " City <br /> Chemicalanalysis mode? Yes ❑ No❑ t,. +ham? t — <br /> r License.No. 321252 Date of this Tepnrt�_�- <br /> _ <br /> WSJ electric l made Yes ❑ No ❑ It, a.:.:r:_c' ylothiaraP't <br /> IF AOOITtONAL UPACE IS NEEDED. USE NE)r CONSECUTIVELY NUMBEREC FORM M ,mss <br /> Own 10111 iRlty.-112 . <br /> ,�1ataYrr•�riAswatiswrr -_ <br />