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18RIGINAL STATE OF CALIFORNIA Do not fill in THE RESOURCES AGENCY le with DWR DEPARTMENT OF WATER RESOURCES No. 219475 of Intent No. WATER WELL DRILLERS REPORT State Well No. Permit No, or D.P W n e r got permit Other Well No.CO S 0 FEZ 4,.1) OWNER: Name M P . O. M Builder Supp1y (12) WELL LOG: Total depth 170 ft. Depth of completed well�2 1 ft. Address P . V. B o X 1 1 0 7 from ft. to ft. Formation (Describe by color, character, size or material) n._ Tracy , Ca _Zip95376 0 5 Top Soil &,-2) LOCATION OF WELL (see instructions): Cuunh A n J a A n 11 J n Owner's Well Number 29 Sand ell address if different from abf)v Eleventh & CabeRL 26 wnship T r ACV Range —Section 2 9 35 Clay Distance from cities, roads, railroads, fences,etc. South West Corne 35 - 45 Sand 45 - 60 Clay 60 - 75 Gravel 5 - 108 C I a (3) TYPE OF WORK: 108 - 119 Gravel New Well 6 Deepening ❑ 1 19 - 170 Clay Reconstruction ❑ _ - Reconditioning ❑ Horizontal Well ❑ - Destruction ❑ (Describe - destruction materials and - procedures in Item 12) (4) PROPOSED USE: y� Domestic Irrigation ❑ lndustnal ❑ Test Well ❑ Stock ❑ - Municipal ❑ _ WELL LOCATION' SKETCH I Other ❑ - i) EQUIPMENT: (6) GRAVEL PACK: a nd & - Rotary Reverse ❑ Yes CX No ❑ Sixe G r l - 13" - ahle ❑ Air ❑ Diameter of bore ' cher ❑ Bucket ❑ Packed from 50 to 12 1_ft• - i;) CASING INSTALLED: (8) PERFORATIONS: 'teel ❑ Plastic CX Concrete ❑ Type of perforation or size of screen ' From To Dia. Gage or From _ To Slot ft. ft. in. I Wall ft. ft. size - 0 121 8 160 101 121 - (9) WELL SEAL: 4'as surface sanitary seal provided? Yes {X No ❑ If yes, to depth--5-0---ft. re strata sealed aga}'pst ollu�'p a? Yes Cl No ❑ Interval . ft. - Method of sealing- 110) L e de n L Work started U -i9 Completed 19 110) WATER LEVELS: WELL DRILLER'S STATEMENT: )epth of first water, if known This well was drilled under my jurisdiction and this report is true tot best at my landing level after well completio knowledge an$ beim. (Well Driller) (11) WELL TESTS: �( Slcxsn Was well test made? Yes No L? If yes, by whom? Ype of test Pump ❑ Bailer El ] ED liftNAME H E N 1V I�!G S BROS . DRILLING CO . , INC . 3ePih to water at start of test fr, Aof est,,,�{ ft Pe o fi o ti a) Typed or printed) t zrge eaI/min after hours ter tterher s 3 5 2 City Zip - � �'a] analysis made? Yes C] No I if yes, by whom? p Ca- A 1453S6 -ctric log made? Yes © No If yes, attalvzz-rr.w,thif WW" ^7 c No. 2 9 0 8 13 Date of this repo IIG 84 DWR 188 (REV.7.761 IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVEL.Y NUMBERED FORM tr