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LIG' INAL' <br /> STATE OF CALIFORNIA Do not fiu in <br /> iTHE RESOURCES AGENCY <br /> 1-i— rrnit <br /> th DWR DEPARTMENT OF WATER RESOURCES No. 076256 <br /> Intent No, WATER WELL DRILLERS REPORT state «.ell Nat ZS ?E -4)4 <br /> No. or Date ./ 37Other Well No • r k_ <br /> OWNER: Name Central Pum (12) WELL LOG: Total dept 5ft. Depth of completed ,en--370t, <br /> Address 1 601 Mono Dr . from ft, to ft. Formntion (Describe by color, character- size or material) <br /> R-) <br /> ~ Modesto Ca. Zip 0 - 1-5--Sand <br /> LOATIQN OF WELL 1 - 21 Clay <br /> cixtnty an Oa uin (See instructions): 21 - 22 San <br /> Owner's �Vrll i`3tunber <br />'e[1 address if different from above 22 — 2 ta ,h\ <br /> .wnship Range w Sectio Distance From cilias, mads milmads, fences, etc. Cy an eCa - y <br /> Well No. 1 Vanderb rc e 38 - 5 <br /> 1- & sas s rea s <br /> 1 - 1 Sand <br /> (3) TYPE OF WORK: 1 C ay & sand Streaks <br /> New Well g[ Deepening ❑ 18 167 Sand I! <br /> Reconstruction ❑ 167 — 0 C <br /> Recunditiuning m qQ5 — J <br /> Horizontal Weil ❑ — 224, <br /> Destruction ❑ (Describe2 0'��\Sand <br /> destruction materials <br /> procedures in Item2 — 426 'Clay <br /> (4) PROPOSED u� 396 Sand- <br /> Domestic 33 _ C�l�pp.Y�� �\\ <br /> Irrigation{.��• �' 0':�—` �} 33,ti1[G' Gla <br /> Industrial � \'` ❑ = 2 Bime sand <br /> Trst, Weil �� ❑ avi`— 6Q• Bliie Cla <br /> StockJ60170 <'` 'Sand <br /> `` 370 - � `=• Clay <br /> Municipal_l <br /> WELL LOCATION SKETCH L.' Other n ❑ — ' <br /> W) EQUIPMEXT: (ti) GRA#VWi,PACK:MC)n;'Prey , — •ri <br /> Rotary ❑ Reverse �res`KNo Sive ,San <br /> Size— <br /> ther <br /> bte f7Air ❑ ater of bore '6 `:❑ Bucket 0 tq� 3 7 <br /> 0 <br /> on <br /> t" <br /> CASING IN5TALLEC):�� {4j-kRFORA'YtQNS: — <br /> f! <br /> eel Plastic ❑ C it td` Type of per(o� n r sfze of screex3•;=�} - — <br /> From ToDia. 6 11 F Tu S!o~�v - <br /> ft. f >in. Wail ft. �; sizes <br /> I[fO- 31T See ttac. a -,s et - <br /> `--/' f or cr-evkk&,. \I. - <br /> lac <br /> 19) WELL SEAL: V - <br /> •ts ssu .X surface sanitary seal provided? Yestin If yes, to dept�0f)ft. — <br /> ere strata sealed against pollution? Yes ❑ No ❑ IntervaL----------ft. — <br /> Metho,d of sealin Work start l9 Completed 19 <br /> 1::LQ) WATER LEVELS: WELL DRILLER'S STATEMENT. <br /> pi of first water, if know ft• Thir uriadiction and this r well tee& drilled under me <br /> nding level after well completion ft. knowledge and belief. t eport is true to the best of my <br /> (11) WELL TESTS: I SIGNED <br /> a as well test made? Yes No C If yes, by whom? P.G. & E • (Well Drillers . <br /> ype of test Pump Bailer ❑ Air lift NA% b g <br /> � p� rienntn s Bros. �riilin uo. 1nc. <br />`ept rcr }s a1 �lt start of test ft. At end of tes l o} Bq�. or eprp ation (T ped or printed) <br /> address_ 0� Y e J.a n a e V-_ <br /> al.'mirt after hours Water temperature _ — •_ <br /> .sl analysis made? Yes U No If yes. by whore? City p_:9.5�p56 _ <br /> as electric lnq made? Yes ❑ No If yes, attach copy M this report License No, 2908^3 riatleaf erilS'r'EDrr - .�2" �v© <br /> DWR 16a tnEV. 7-7e1 IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />