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r <br /> IOINAL STATEOF CALIFORNIA Do not fill irewith DWR THE RESOURCES AGENCY <br /> p� <br /> DEPARTMENT OF WATER RESOURCES NO. 106275 <br /> it +of Intent No WATER WELL DRILLERS REPORT Stite well No <br /> I'l,nntt No or Dtte 78-1185 Other Well No " f <br /> (I2) WELL LOG <br /> 1ot,l depth Et Depth of completed well ft <br /> +s E Watters Rd front ft to ft Forniihon (Describe by color charlcter sire or mlteriil) <br /> t� F ench Cam Califvrnla Z,t, - 3 Sandy Leam <br /> (2) I,OC'ATION OF WELL3 - 14 S <br /> (5t_c Instntchons) <br /> "Ot�- Owner. 'DLII Number 34 <br /> _ 22 t-lay <br /> - <br /> cll uldress If ditft.rent front thrive 22 34 Sand wZclav streaks <br /> onntihitt Rime. —'se,tion _34 40 Clay <br /> lJtstince from cities mads railroads fences etc 40 — 70 Cls w sand streaks <br /> 70 - 98 Course sand w clay streaks <br /> 98 - 134 Brn,& Blue clay w sari <br /> - streaks <br /> (3) TYPE OF WORK <br /> New Well CK Deepening ❑ <br /> Reconstractinn 0 <br /> Reconditioning ❑ <br /> Horizontal Well ❑ <br /> Destruction ❑ (Describe — <br /> destructinn materials and <br /> procedures in Item 12) — - <br /> (4) PROPOSED USE - <br /> Domestic ($ _ <br /> IrnK2tion ❑ _ <br /> Industrial 0 = <br /> Test Well ❑ <br /> Stock ❑ _ <br /> Municipal ❑WELL LOCATION SKETCH Other ❑ — <br /> QUIPtiIENT (6) GRAVEL PACK — <br /> rt try (g Reverse ❑ Ye$�[ No ❑ Stze <br /> hie ❑ Airtt _ <br /> ❑ Diameter of bore <br /> then ❑ Bucket ❑ Packed from 50 to 134 ft — <br /> t) CASING INSTALLED (8) PERFORATIONS = <br /> el tQ Plastic ❑ Concrete ❑ Type of perforation or size of screen <br /> From To Dia Gage or From To Slot <br /> ft ft to Wall ft ft size _ <br /> 0 Ii - <br />� WELL SEAL <br /> as surface sanitary seal prnvrde(P Yes ❑ No ❑ If yes, to depth-------ft — <br /> 1Icre etrata +ealed against pollutions les ❑ No E Interrll_ ft — <br /> Method of seihn Vvork started 19 Completed 19 <br /> e0) WATER LEVELS WELL DRILLER'S STkTENIENT <br /> epth of first water if known __-- B This taell tens drilled Linder my )urisdwtion and this report is true to the best of inn <br /> Stinduag le1el after well completion ft knonledge and belicf <br /> 1) WELL TESTS y SIG-,ED <br /> I' well to+t m ide? Yes Vo ❑l If ves by whom («ell Driller) <br /> pe of test Pump ❑ Bider ❑ Air lift ❑ <br /> N k%,iE.. NOack_P>lm�0n , <br /> Depth to tater it start of test R At end uk test ft Persu fl <br /> rm o cf{�{ora[wn) (T�ped or panted) <br /> iacharge — Bali nun after,,,, hour+ «Ater femperature <br /> Address P 06 o hoS `J' V+:S <br /> Stockton, California 95201 <br /> LI analysis made? Yes 4 \a C] If yes by whom' Ciri Yip <br /> electnc lot; made° Yes ❑ No ❑ It yes attach copy to this report License No 355213 Date of this report <br /> F,188 REV 7 16i IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br /> I <br />