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t. <br /> ORIGINAL STATE of CALIFORN[A Do not fill in <br /> THE RESOURCES AGENCY A� <br /> ie with DWR DEPARTMENT OF WATER RESOURCES NO. 071438 <br /> of Intent No. WATER WELL DRILLERS REPORT <br /> cat'Permit enni[No. or Date State Well No. <br /> Other Well No.Q <br /> t1) OWNER: Name Bob Hall (12) WELL LOG: pt�Q p 95 <br /> 24 LV. Emerson Avenue Total de ft. Depth of completed wel) ft <br /> a Idress from ft. to ft. Formation i Describe by color, character, size fir material) <br /> ,• <br /> Tracy, CA Zip 95370 0 - to soil <br /> t2) LOCATION OF WELL (See instructions): 1 18 clay <br /> County S n Joa cluin Owner's Well Number 1 11 <br /> g - 2 sand . <br /> ell address if different from above 24 - � cla y <br /> lrwnship Range Sectio 46 - b3 grave <br /> e <br /> Distance from cities, roads, railroads, fences,etc Old highway 50 - 5 c1,a <br /> 800 , west of Chrisman next to Hart F 65 - 73 gravel <br /> Electric 3 - dU c ay ' <br /> 80 90 sand <br /> (3) TYPE OF WORK: go 1_5_0 clay _ <br /> }}}...... <br /> New Well 2' Deepening ❑ <br /> { Reconstruction ❑ - - <br /> Reconditioning <br /> liurizontal Well ❑ - "- <br /> Destruction ❑ (Describe = - <br /> destruction materials and <br /> procedures in Item 12) <br /> (4) PROPOSED USE: - <br /> Domestic A 21 = - <br /> Irrigation Cl <br /> Industrial ❑ - <br /> Test Well ❑ <br /> Stack 0 - ` <br /> Municipal ❑ <br /> WELL LOCATION SKETCH Other - 0 - <br /> 'M) EQUIPSIE Vr: (6) GRAVEL PACK: - <br /> Rotary [� Reverse El Yes 2 No ❑ SizeEirdse e <br /> .hle ❑ Air ❑ Diameter of bore 1 tt - <br /> &, her ❑ Bucket ❑ Packed,from 50 tor95 <br /> t. - <br /> (i) CASING INSTALLED: (8)-PERFORAT[ONS: - <br /> :el ❑ Plastic ❑ C6ncrete [] Type of perforation or-size of screen.; - <br /> G .From To— Dia. dagi_rnr From, To Slot.-,. <br /> ft. ft. �` in. Nall in. ft. siz - <br /> 0 95- 1 0 65 70- : screen - <br /> r`., I <br /> 1g) WELL SEAL: <br /> as surface sanitary seal provided? Yes [' No ❑ if ves, to depth 5 0 ft. - <br /> &o+ere strata sealed against pollution? Y ❑ No C) Interval Ft. - <br /> Method of sealing— YC] <br /> Il ork started rc 9 Complet 16 <br /> .0) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> epth of first water, if know ft. This well was drilled under my jurisdiction and this report is true to the hest of my <br /> *!'[ending level after well completion ft. knowledg yr+dd b�eh , <br /> (11) WELL TESTS: SIG\taD / / l -�/ LIIL <br /> MSQ <br /> as well test made? Yes ❑ No a If yes, by whom? (Well Driller) <br /> ,pe of test Pump ❑ Bailer ❑ Air Ifft ❑ NAME: Hennings Bros o Drilling- Co. , Inc. <br /> 4—th to water at start of test w ft. At end of test-------ft e n, rm, or corrratict (Typed or printed) <br /> sge Qal/min <br /> after-_--hours Water temperature Address 352 e1anda�e I�VEnLle <br /> Modesto California ip b <br /> t � analysis made? Yes ❑ No (�If yes, by whom? � _C!n' 7�n,., tl <br /> as electric log made? Yes ❑ No L' If yes, attach copy to this report License No. 290 �3 Date of this report March 2-5 s 98C <br /> DWR 186 (REV.7.76) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br /> V <br />