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;7 OP--�c v� <br /> L�� Q Do not fill in <br /> Q3lADRL"PLICATE \� ,) ��Te or<wuroRralw <br /> U:O to comply with ij1� gtESOU RCES AGENCY NO 128667 <br /> local r_gcirements 1yp` . T OF WATER RESOURCES 1' v <br /> SpP{c' VATER WELL DRILLERS REPORT <br /> H4f'• Sltle t\'ell.n <br /> c,n.r ul Inlmt],,. <br /> pher Well.n. <br /> Lsnl 1•mnit.e.m Dnte <br /> (1) OWNER: ..m'-2Z2-31+--s-.---UnionFrank Machado (12) WELL LOG: T..nl dr,lti�R.Depth M t+a rnn+Ple .eller✓ <br /> Addmn_. Av. Inm. !t. en ft. PonnnNnn nInenrow lw mho, rhnnrter. +be nr mN <br /> .teil <br /> Manteca, a• %in— y9IId7 i <br /> 2 <br /> : <br /> I (2) LOa' IOOFV LL lSta•instmction.): _ $ nd <br /> 8 M`ra QR D..n.•:.tcell.nmh.. t6 - 2,15 CIA ` <br /> tern:,aan a dwewm mm nin. eye <br /> n.nnxM:+ none. D V9 <br /> saa mn <br /> Dixlnnrt fn•m title+,nmJ+.mdnaJa,leuex, <br /> south oY Perrin Ave. eas s • My <br /> a <br /> (0) TYPE OF WORK: <br /> .e.t Well Z Dernenine ❑ - - <br /> Ii.z.mnmcunn ❑ - <br /> Cw <br /> Irn.:woi:.nine ❑ i � <br /> W:d.nmd tern ❑ <br /> Ih+mminn G (Ih+rrihe \ �''- \V) (l\\ <br /> nrw um in Itelft 12Y - <br /> (J) PROPOSED OSE: 9 <br /> Dmm,tiv <br /> LrinetMn.' a - <br /> IMn+tdd ❑ Ct- AA <br /> TI Nell '�' ❑ - <br /> Snak, <br /> i t\'RL1. LOCATIO. SCRTCiI //`/, (hher ❑ <br /> 131 EQUIPhiF.]T: lel CRAVRL,PACK: <br /> Sb. <br /> L_ GM1k ❑ Air 13ti <br /> u\iT'ter.d M.w <br /> Other ❑ R+rket ❑ PL1NYnm: 41�. \':1 <br /> ICI CASI9C 1.STALLED:Cr tAIPRRFORATIQ.e: - <br /> steel❑ P1.11. CnA'�t T>'pe^1 Iwr�lim nr 0. n1 umn'<� - <br /> Fmto To Die. Gnf Ole Fruvi\\ (L <br /> ft. f :in. Wall IL`'.`C' <br /> \ \ •.Sore - <br /> (9) WELL SEAL: <br /> r'n+nd.re vnimry e.1 PeMil ' V,,[� ye,h.Jeprh__jv.._ft. <br /> \Cew Nrat. +e.led .ceimr pi'llWinn' t'e+❑ Sn u Inwrv.l A. mmn 19 C'`'ooler d 19_ <br /> hleRnd nl snlin <br /> (10) WATER LEVELS: WELL DRILLERS STATEMENT: <br /> Depth .d lint -'t". it Y+.•.. .rep R. Thl. oll doPea ..it,, mV iaMend thi. I+ er++e <br /> adielm. rnn•n rn tM heq M my <br /> Ic knruleder end Will. .: , <br /> i 5lmdine heel titer..ea wwnrkJ� •/l" /!/ .•l '%i '/4r4 '311 r'l. <br /> SIGNKa tt'ell Drilkrl <' <br /> j (11) WELL TEST'S. pn��1 <br /> W., veli It mode' Tea e V••Ex 11 le., by ..h•nn? Air lilt❑ Reasinaa yrl�a Ih'SIZSnR Co+.time <br /> Ppmn ❑ R.ik+❑ \A\I xxd nr etC <br /> Depth J'. r.hT .t ,t.+' M t.,—It- n At eml ,J tear Ir Addrte+ '4�I i0iGKnaa�ey.•: vri — <br /> .•nlrMn .nm hon a'.tm tnnl•rmp,w Modesto cat, �In 95350 <br /> Di+dtnree Cih <br /> c+rmk.l .wx.i+ m.arr rn a .:: li II .rx. by ne:.n 290 13 Au M thl+wl.: <br /> : tem rh.+dr u.c m.aet rep G .eau.rx.,mrh r.rox m rnix wm�d urm+e.n� <br /> owR lee .nev.+•+e. IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br /> I <br /> -r`u�RrEDRODU�TL04�� � <br />