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Do Not Fill In <br /> 1.011" STATE OF CALIFORNIA 4t <br /> ORIGINAL THE RESOURGESAGENCY NO 143579. <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> Sate Well No. <br /> WATER WELL DRILLERS REPORT Ocher Well No 76348 W <br /> (1) OWNER: (11) WELL LOG: <br /> Name O .J. POZZ1 Toe.l d<psh <br /> 120 is. Depeh of eample,ed—il 120 Is. <br /> Address 10 1 Moffat Blvd. Fono.don: D....ib,by roto.,,b....tees sive of <br /> s.m £` <br /> Manteca Calif 0 dy loam <br /> (2) LOCATION OF WELL: 16 coarse Band <br /> Owner's number.if a-y <br /> rR�C <br /> �9vary �^Sp 0 1 b W.L <br /> Tuwnship.Ran e,and Semon i1T fP 'a �of e <br /> aide of Mo8 Band <br /> Dar,nee fmm.icier.rod,.nilroada.nc. Ne MOM <br /> 11 brown clew* <br /> )0 west of Austin <br /> (3) TYPE OF WORK (cbecla): 116 120 Band ravel <br /> New Well;] Deepening ❑ Reconditioning ❑ Destroying ❑ <br /> if destruction,describe material and procedure in Item I I. <br /> (4) PROPOSED USE (check): (S) EQUIPMENT: <br /> Domestic ❑ Industrial ❑ Municipal ❑ Rotary ❑ <br /> Irrigation X] Test Well ❑ Other ❑ Cable i9] <br /> Other ❑ <br /> (6) CASING INSTALLED: <br /> If gravel packed <br /> STEEL: OTHER: <br /> SINGLE] DOUBLE <br /> Gage Diameter <br /> From 'Ib or of From TD <br /> ft. ft. -Diem. WA I Bore f[. fc. <br /> 0 2 1 10 <br /> _ 0_ 2 10 10 iv er well Beal waa. installed on <br /> and I a.r" net reg nsible for <br /> f the seal <br /> Y,rr of shoe,..well ring: 14x6x 8 <br /> 0 8 <br /> Un ri De i.dm <br /> (7) PERFORATIONS OR SCREEN: <br /> Type of Pert—Jan-r of a <br /> Nrf. Rows <br /> From To per per Size <br /> ft. f[. row ft. in.x in. <br /> (8) CONSTRUCTION: 2 <br /> Wn a surface uaiory R.1 Provided? Ye. No C3 To rho,depth Is. <br /> Were any uuu sealed ax.im,pollution? Yes o No^ If y...nom d.p,h of non <br /> Fmm f..m is L - <br /> Worp.' d 19 6 .Completed ^ 19 <br /> bm,n is.to It. <br /> a WELL DRILLER'S STATEMENT: <br /> kis,hodofaralfng Cem QTif,111 <br /> This wolf was drilled ander my jvisdirtion and this repay[ is true to the best <br /> (9) WATER LEVELS: of my kna,,1,dge and belief. <br /> Uep,h a,t which worse w.,yrs, found, If known 1 f`' <br /> ss.nding level ,F... met...ring. if known f,. NAME Jehn P8 , <br /> (Person,tern, <br /> rm,or eprporanon) (Typed or P•iwsrd) <br /> Sonditslevel after .(arida1 sod devil ina I,. <br /> (10) WELL TESTS: . Escslon -.lif. °: 20 <br /> . . Address 11 _ S. Van Allen <br /> Was pump rest made? Yes O No C) If Fee.by whom. <br /> Sr.drawdown af«r hes. [SIGNED] <br /> yield: xal.(min.with (Well Dr,ller) <br /> Temperature of water W»a chemical amlpis model Y., ❑ No ❑ C-724 6-30 l9� <br /> W.,dm,n,I.,mae o <br /> df welU Yes El No ❑ if y,,,areach copy License No. 1 G G Dattel <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> e.ya aoR ynv a asp <br /> DWR 188 (REV. 9661 <br />