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MIGINAL STATE OF CALIFORNIA Do not fill to THE RESOURCES AGENCY il.with DWR DEPARTMENT OF WATER RESOURCES No. 129418 stent No 159640 WATER WELL DRILLERS REPORT St HL 1i ell 10 It No or DateZ N ! �"- i Other dell ho 1 7EZ ! OWNER ,,rRme Jam JJkns ori (12) WELL LOG Tnt it depth 210 ft Depth of completed sell 21 O{t 4 [Idreyq 38 Felton wayfrun. ft to ft FsmuuUun (Destnhe by color character sire nr m ntrnat) toe ton Zip 0 - _74 Adobe LeCATIFN OE WELL (See instnictions) - 21 Brittle Gla nnnt5 an oaquin Owners %Nell lumber 21 -' Soft, brown clay laddress if different from above - 80 Fine sari ship Ranee —section ector du 87 Clay -1, )istance form cities roads railroads, fences etc 71"p,1 E. - Small gravel Fairchild, St6ckton 5P6 - 106 CINY7 j (3) TYPE OF WORK { NeN. Well Deepening ❑ 't LI3 Recnstruchun ❑ / gretve [�} Reconditioning ❑ - I onzuntal NL ell ❑ 354 5=1 and clay layers 370 elftY and gravel Destruction {j (Describe ` - destruction materials and I`i5c--: Procedures in Item I2)' - - (4) ]PROPOSED USE. 209 209 Gravel and sand Domestic Irrigation ❑ -Industrial El /Cr /-`r f Test W ell 0 - Stock {3 - Municipal 13" - -WELL LOCATION SKETCH •` Other ❑ P.1-vpqr Welt cover, war. tristaTled EQUIPMENT (6) GRAVEL PACK Uri - responsible lotan Reverse ❑ Yes [?C No ❑ sizeems" e ❑ Ar 10" . ❑ eter of borrer - - 1 r ❑ Bucket ❑ .from J9_,__2 0 r CASING INSTALLED,^-�, (8)''PERFORATIONS - saw cut ^ Leel ❑ PlashcxCo>ac�ete ❑ T3,pe of per(otr"n or-skze of screen - M To Dia G r F� `� To �y ft to Wall ft. - 21_9 0 PVC 1 50> 210, 1 ""x - 9) WELL SEAL Cn t urface samtary seat provided+ les ®[ No ❑ if ves to depth50ftstrata sealed against poll tions es ❑ No I_X Intervald of 5eahn c emeA l[ark gtart _ 19 Complet 19 10) W46TER LEVELS 15 ELL DRILLERS STATEk1E1NT f first water if knmNn,.�.,_, ._ ft This well was drilled under mr r rurradeehan and thin retinrt es ince to the best of mq fd..'glevel after wellr�impletior ft knowledge and bebef WELL TESTS SSGIED fns well te,t made Se, ❑ ti�jNrj' If Nes by whom' 7� ON ell Driller) C of test Pump ❑ Bailer ❑ Air lift ❑ NAME Pa.nerto Wle Drilling; Inc.- Ith to water at start of test k At end of tes��fi 1, (r erson firm nrcorpo hon) (T ed or anted) pelemLtnc al/min after hours Water temperature Address 14iJ E+• Lonefree lfoa"�nal5sis made4 )e, ❑ Nn ❑ If Nes by u hnrn Citi Oakdale, Califs Z 9S Ing rriade� Yes 0 \To ❑ If Nes attach copy to this report License No 33 Date of this report /29 189 (REV 7 761 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM 1 6