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STATE OF CALIFORNIA Do Not Fill In <br /> THE RESOURCES AGENCY N� 99426. <br /> nupi�catE DEPARTMENT OF WATER RESOURCES <br /> Retain this copy WATER WELL DRILLERS REPORT State Well No. <br /> j Other Well No. 5 I✓ <br /> 1' (1) OWNER: (11) WELL LOG: <br /> i <br /> Name Total depth 98 ft. Depth of completed well 92ft. <br /> Address Formation: Deirrfbe by roles,cbarseter,size of material,and structure <br /> f <br /> it,to Tep sail ft. <br /> (2) LOCATION O WELL: <br /> County sail jeaquin Owner's number,if any <br /> Clay shale <br /> Township,Range,and Section T46 R79 9 20 15-47 Sand <br /> Distance from cities,roads,railroads,eta 91V 55 <br /> - <br /> (3) YPE Op Wkk_(cJlecU 57 60 shaln <br /> 1 New Well k Deepening ❑ Reconditioning ❑ Destroying ❑ 60 <br /> rt <br /> lay shale <br /> if destruction,describe material and procedure in Item 11. <br /> 75 79 Sand <br /> (4) PROPOSED USE (Check): (S) EQUIPMENT: <br /> DomesticIndustrial ❑ Municipal ❑ Rotary 79 80 Gia,J <br /> Irrigation� Test Well ❑ Other ❑ Cable ❑ 99 98 Glay shale <br /> Other ❑ <br /> (6) CASING INSTALLED: <br /> 6T EELy _ OTHER: <br /> If gravel packed <br /> SINGLER .DOUBLE ❑ <br /> Gage Diameter <br />` From fo or of From To <br /> R ft. ft. Diam. Wall Bore ft. it. <br /> 0 no A 12 12 60 921 <br /> x <br /> 1rravel:R <br /> Size of shoe or well ring: Size of - - <br />_ <br /> UesCribe joint ifelded <br /> (7) PERFORATIONS OR SCREEN: <br /> Type of�erforatiois oc.mime of screen _.p.. - <br /> I <br /> Perf. Rows <br /> From To per per Size <br /> ft. ft. row ft. in.x in. <br /> 9E) 92F <br /> I 1! <br /> r <br /> (8) CONSTRUCTION: <br /> Was a surface sanitary seal provided? Yea No ❑ To what depth ft. <br /> I <br /> W.I.any strata sealed again,,pollution? Yes❑ No Q If yes,note ep,h of sera[. <br /> From ft,to ft. <br /> From fc.to ft. Work started [9 ,Completed 19 <br /> Method of sealing PenterAte WELL DRILLER'S STATEMENT: <br /> (9) WATER LEVELS: This well was drilled under my jurisdiction and this report is true to the best <br /> s of my knowledge and belief. <br /> Depth ac which water was first found, if known ft. <br /> 1 <br /> Standing level before perforating, if known ft. NAME <br /> Snndin level 9feer perfor26ng and developing ft, erson, rm,or corpora[ron) ( ype r prinled) <br /> (10) WELL TESTS:' Address2:500 t <br /> Was pump test made? Yee No If yes,by whom2 MAJ.1@gto 9r) <br />{ <br /> Yield: s;al.lmi with ft.drawdown after hrs. [SIGNED] - <br /> Temperature of water Was a chemical analysis made? Yes ❑ No (Well ri er <br /> Was electric log made of well? Yes ❑ No - If yea,att.eh copy License No__2 908 13-Dated <br /> r <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 188 (REV.9-da) 35179-950 9.69 SOM TRIP AO OSP <br />