Laserfiche WebLink
ORIGINAL STATE OF CALIFORNIA <br /> Do not fill in <br /> THE RESOURCES AGENCY <br /> =ile with DWR DEPARTMENT OF WATER RESOURCES No. 076041 <br /> of Intent No. WATER WELL DRILLERS REPORT State Well No. <br /> •[Permit No. or Date Qj —589 Other Well No.d zs p <br /> 1) OWNER: Name Don Most (12) WELL LOG: Total dep 1 0 ft. Depth of completed we 0 ft. <br /> Address 8691 Almendra from Et. to ft. Formation (Describe by color, character, size or material) <br /> .:ih' Tracy Ca. Zip 0 - _Topsoil <br /> L. 2) UgGAn I?� QUV�ELL (See instructions); 2 C la <br /> County �-a Q Owner's Well Number 25 Clay-hard <br /> Well address if different from above - Sanei,\& grave <br /> T„µ-nship 0.2-5 <br /> Z 5 Range a S Section- - ay <br /> Distance from cities, roads, railroads, Fences,etc. <br /> $ 0 11th St.- - an (ScgraveT <br /> S.W. corner of 11th St. & Cabe St. 1 75 - 81 `•q <br /> Tracy 81 - 8; , Stnd & gravel <br /> 8 - 1 -V'—Clay <br /> (3) TYPE OF WORK: 114 145\> Sand & gravel <br /> New Well X Deepening C: 14 v1� 1 50 Clay <br /> Reconstruction ❑ _ \\ <br /> Reconditioning _ ♦ �? <br /> Horizontal Well ❑ <br /> Destruction ❑ (Describe <br /> destruction materials acid <br /> procedures is Item 12�' <br /> (4) PROPOSED Um. <br /> Domestic - \ <br /> I.a Irrigation ��� ❑ '.�� �' `�'� . <br /> f Industrial 1 , ❑ - <br /> Testi.Well \ ❑ � , - <br /> i.r� <br /> Stock,.', <br /> i� Municipal\'. ❑ <br /> WELL LOCATION SKETCH ti •,y. Other4+ •:^� E] - <br /> �{5) EQUIPMENT: (6) GRAVELIXACK.Roof-ing^ - <br /> ti <br /> RotaryIx Reverse ❑ Yes (g No ❑ 5izevel <br /> 1t <br /> able \ t? �� _ <br /> ❑ Air ❑ \meter of bore <br /> 3ther ❑ Bucket ❑ Ns x nm to t S f(7l CASING INSTALLED:,`r'•�\ (8) PERFORATIONS: - <br /> Steel ❑ Plastic IX Cortcrate C% Type of per(niaban or'3ae of screen,-;7- � - <br /> rr From To, Dia. Gad or Frowk � To <br /> ft. ft(� Jin. Wall ft\.\-\z ft. size <br /> 0 150 ` 160 130 15 ',screen - <br /> (9) WELL SEAL: >y Was surface sanitary seal provided? Yes No ❑ If yes, to depth,-50_.. ft. - <br /> imWere strata sealed against pollution? Yes ❑ No 0 Interyal ft. - <br /> Method of sealing ems Work stn 19 Completed 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if known ft, This well was drilled under m <br /> y jurisdiction and this sport is true to the best of my <br /> Standing level after well completion 1 n ft• knowledge and belief. <br /> (11) WELL TESTS: SSIGNEDWas well test made? Yes E] No t4x If yes, by whom? (Well Driller) <br /> Type of test Pump ❑ Bailer ❑ Air lift ❑ NAME Henninds Bros. Drillin C Q. T ne o <br /> Depth to water at start of test ft. At end of test ft Pe o fi or co r tion) Typed or printed) <br /> ._ _." 3�2 3 nP Ma nr f e Ave . <br /> karge nal/min after____�ours Water temperature- Address <br /> " Modestol Cao Zi 95356 <br /> „r.• cal analysis made? Yes ❑ •No •If yes, by whom? City n n p <br /> Was electric log made? Yes ❑ Na ,If yes, attach copy to this report License No. 2 mate of this report 8 G O <br /> VRwR tee ease. -yet IF ADDITIONAL SPACE 1S NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br /> .. t •�r a <br />