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Do Not Fill In <br /> STATE OF CALIFORNIA <br /> ORIGINAL <br /> THE RESOURCES AGENCY NO 143579 <br /> Pile with DWY DEPARTMENT OF WATER RESOURCE <br /> WATER WELL DRILLERS REPORT State Well No. <br /> Other Well No. 76348 W <br /> (1) OWNER: (11) WELL LOG; 0311% <br /> Name O .J. Pozzi To,al d<pch <br /> 12® ft. Depth of eom Irmd well 1 <br /> Address 10301 Moffat Blvd a Focmadon: Dmrrlbe by ralm,rh.,rr<r,size o/moudal,sad nnrrnr <br /> ft.. fu. <br /> Manteca calif 0 to sand ball <br /> (2) LOCATION OF WELL: ` 1b coarse sand <br /> Y <br /> r wn hip.Ran ana s«, T-2-S n �ymb<r.ifgee• 0 1 to r ®1R <br /> Dia[anc<fru.r,tsa.<..dl,.railroad+.<,c. NO.M11 aide •f Mo fa sand <br /> )01 west of Austin 68 116 brown cravellaT <br /> (i) TYPE OF WORK (check): 116 120 sand-6 <br /> New Well] Deepening ❑ Reconditioning ❑ Destroying <br /> If denrucison,describe material and procedure in Item 71. <br /> (4) PROPOSED USE (check): (S) EQUIPMENT: <br /> Domestic ❑ Industrial ❑ Municipal ❑ Rotary ❑ <br /> Irrigation gJ Test Well [_1 Other ❑ Cable <br /> Other ❑ <br /> (6) CASING INSTALLED: <br /> If gravel packed <br /> STEEL OTHER: <br /> SINGLE] DOUBLE ❑ <br /> Gage Diameuc <br /> From l'o or of From To <br /> ft. it. Diam. Wall Bose ft. ft. <br /> 0 2 1 10 <br /> 10 10 xo er well seal was, installed on <br /> 4 a :3T 'Jr net resrensible for <br /> 14x6x 8 Os6z 8 i t= Ji e r relic r r< o f the e .l <br /> Sa of,hoe well ring `a <br /> U<nribe loin+ <br /> BUttweld r I, n _ <br /> (7) PERFORATIONS OR SCREEN: <br /> TYPe of perluratiun ur nam<of <br /> Perf. Rows <br /> From To per per Size <br /> ft. ft. row ft. in.x in. <br /> (8) CONSTRUCTION: <br /> Wn a,ur[ace upivary salt provided? Ye+ a No C To wh.,drp[h 2 fro <br /> Wer anv, Baled againu poll u+ Yes❑ No C If res a dip[h of a[ <br /> n <br /> uta• Wor�am d 19 6 .Cnmple[ed 19 <br /> hnd of ol.ng <br /> WELL DRILLER'S STATEMENT: <br /> cementin <br /> This well was drifted under my jurisdiction and this report is true to the bort <br /> (9) WATER LEVELS: of my knowledge and belief. <br /> Urp,h a, which wa,< wm fin, (oond,if known 1 1,. <br /> t,andina lewd before p<rfonalne, if knnwn f<. NAME Jean PBIIeTe <br /> (Perron,firm,or corponnon) (roved o.prianp <br /> Smndin level af[<r iarfoein., and d«<lo iiia f,. <br /> TE _ Address 11 Be Van Allen <br /> (10) WELL STS: . . 5 20 <br /> W., m <br /> pup mi made? Yet ❑ No D If yn.by rho.? <br /> Lscalon ��.lif, <br /> &.drawdown,f,er hes (SIGNED] <br /> Yield: @h (WdI D•illrr) <br /> Temp<rawre of weer Waa a chemical analy+is madd Yo D No ❑ 72 1, aced 6-30 1916 <br /> W n d¢vic log made of.dl? Yea ❑ No ❑ If To, i.cb ropy License No. ♦± 1 GeT i] <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> 4l3 JOM TPIP(DT car <br /> DWR 188 (REV. 9-.a <br />