Laserfiche WebLink
*wRIGINAL STATE OF CALIFORNIA Do not fill in <br /> THE RESOURCES AGENCY n' <br /> File with DWR DEPARTMENT OF WATER' RESOURCES Na, 168907 <br /> 4.of Intent No. WATER WELL DRILLERS REPORT State Well No. <br /> { ermit No. or Datf_-e8 37 2 Other\irel[ N.4.0 S 0 V <br /> ) OWNER: Name Briar. Stenger (12) WELL LOG: Total <br /> deptt�1Lt. Depth of completed we1L_7Oft. <br /> from ft. to ft. Formation (Describe by color, character, size or material) <br /> Trac r, Calif. zip 0 - 53 Ton soil cls T <br /> y } LQCATION OF,WELL (See instructions): 6 Caravel <br /> C:ciunty '�ar J O a urn Owner's Well Number - .pro W71 clay <br /> Well address if different from above <br /> 25111 Chrisman Rd. ?5 - 81 Gravel <br /> mnship Tracy .Range Sectio 8'11' c Brown C ay <br /> 4i'llstance from cities, roads, railroads,fences,etc. S4 — 87 Gravel <br /> 8 - 217 Brown clay <br /> (3) TYPE OF WORK: <br /> New Well X) Deepening ❑ — <br /> Reconstruction ❑ — <br /> Reconditioning ❑ _ <br /> Horizontal Well 0 <br /> Destruction ❑ (Describe — <br /> ` _ destruction Imaterials and — <br /> r <br /> procedures in <br /> Item 12) <br /> (4) PROPOSED USE: <br /> Domestic -oriv <br /> Irrigation <br /> Industrial ❑ — <br /> Industrial ❑ <br /> Test Well ❑ — <br /> Stock ❑ — <br /> Municipal ❑ <br /> WELL LOCATION SKETCH Other ❑ <br /> i} EQUIPMENT: (B) GRAVEL PACK: - <br /> totary in Reverse ❑ Yes INy No ❑ Size r <br /> n <br /> Cable ❑ Air ❑ Diameter of bore - <br /> her ❑ Bucket ❑ Packed from �� tart. - <br /> Arf) CASING INSTALLED: (B) PERFORATIONS: — <br /> Steel ❑ Plastic M Concrete [I Type of perforation or size of screen — <br /> Froin To Dia. Gage or From To Slot - <br /> ft ft in. Wall ft ft size - <br /> Ct 6 160 70 Q <br /> PSI - <br /> r <br /> (9) WELL SEAL <br /> Was surface sanitary sea] provided? Yes Q9 No ❑ If yes, to depth 5 5 ft. <br /> Tete strata sealed against pollution? Yes ❑ No ❑ Interval _.ft — <br /> Irethod of sealing. Work start 19 Complet — 1917— <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> nepth of first water, if known fit• Thi, well wos drilled under my jurisdiction and this report is true to the best of my <br /> tanding level after well compled ft. knowledge and belief. ) <br /> G'11) WELL TESTS: SIGNED / Bkk r. <br /> Was well test made? Yes ❑ No ❑ If yes, by whom? (Well Driller) <br /> Type of test Pump C] Bailer [3 Air lift ❑ NAM Calwater DrillingCo . , Inc. <br /> iepth to water at start of test ft At end of test ft Person firm�ror corporation) (Typed or printed) <br /> 'urge gal/min after hours Water temperature <br /> Address 360 J • Kilroy <br /> I City Turlock_._ Calif. . 9538Qip <br /> � al analysis made? Yes ❑ No ❑ If yes, by whom. { R�7 <br /> .electric to made? <br /> Yes -nate of this report, 10^23—"r <br /> g ❑ No ❑ If yes, attach copy to this report License No <br /> ,dWR 188 (REV.7.761 IF ADDITIONAL SPACE 1S NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br /> i.r <br />