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1 Do Not Fill In <br /> STATE OF CALIFQRNIA <br /> CtiOiHi#L THE RESOURCES AGENCY <br /> !il•with owt DEPARTMENT OF WATER RESOURCES j-'N�TOft 116.6 9,3 <br /> I' WATER WELL DRILLERS REPORT State WeE{Not 5PL — � 1 <br /> Other Well N <br />' (I) OWNER: (1 1) WELL LOG: <br /> Name Tony Payan To-1 depth 256 fr. Perth of completed call 253 fr. <br />' Address S• ly an eca Formation: Dnrribe by rafor,chdr.rler,ai=r of metrrvd,rid[warfare <br /> ant e ca a 1 fr.to ft. <br /> (2)' LOCATION OF WELL: — —top soil <br /> QCounty van Joaquin Owntr's numbce,if any sand <br /> Township,Range,and Section west fl 1'1 S. an eco clay <br /> Distance from cities,toads,railru.ds.*;'m .. -z 500T s out of "' 3-5San light clay <br /> Cotta 35-W clay <br />' (3) TYPE OF WORK (check): = sandcoarse san <br /> ff- <br /> News Well 1. Deepening Q Reconditioning ❑ Destroying © May <br /> 11 destruction,dtscribr material and procedure in Item 11. — san <br />' (4) PROPOSED USE (check): (S) EQUIPMENT: — clay san S T'KS <br /> Domestic C3 Industrial ❑ Municipal ❑ Rotary �55 clay <br /> Irrigation M Tesc Well ❑ Other ❑ Cable ❑ sand clay 5 real—s <br /> Other ❑ - san coarse sand <br /> ' (6) CASING INSTALLED: L IR c ay <br /> STEEL: OTHER: <br /> If gravel packed sand stone <br /> SINGLE ?� DOUBLE L' ay <br /> ' = J san <br /> Gage Diameter clay <br /> Froin 1'u or of From To <br /> it, tc. Diem. Wall Bore ft. it- <br /> Wall sand coarse san <br /> ci <br /> ' Ah 58 2411 1.25UT - clay . <br /> • + � sand <br /> �73 _=3 2 •2 -189 c ay <br /> S.x ud,hoe or .vitt ring: Sixe of eravei: it S e,Tre —192 sanci <br /> Doc,ibc w.n[ —220 soft C I ay <br /> (7) PERFORATIONS OR SCREEN: 220-230 clay 3c, sand strks <br /> ' <br /> Type of wtiorx[iun ur name of screen 230-25i sang, coarse sand <br /> Pcrf. Rows 251-256 clay z, lignt sang s_ r <br /> rs <br /> From To per per Size <br /> fr. fr. row ft- in.x in. <br /> ' 73 7 3 x + <br /> x <br /> 2? x 3 FT <br /> ' (8) CONSTRUC'T'ION: <br /> Was a.uriace sanitary sell provided? Yes ;Yo ❑ To what depth 50 ft- _ <br /> ' Were env strata.caicd aninst pollution? Yes Cl Non If vt..note depth of atrar. <br /> From fr.to it. .7 <br /> Frush ft.co (r. 9rock carted 2-1 19 f r7 4 ,eompieeed 2-14 19 74 <br /> Aerhod of,e.lioit WELL DRILLER'S STATEMENT: <br /> (9} WATER LEVELS: This well was drilled undrr my jurisdiction and shit report is true to the best <br /> of my knowledge and belief. <br /> Depth at which .ace war fine Fouad,if kaown ft. r, <br /> ' k °��ell 4.w .:r- u.a) • Co .o Inc . <br /> 5tandinit levvl before perforatine, if known ft. <br /> NAME Q f' u <br /> (retsoa,firm.or cu......um.j i s ri'r,:v r•i-:•J} <br /> lnndinR level afar petfnrarin)t and develo init f[. <br /> o) WELL TESTS: ;7 r Address 1825 Yosemite+Blv{d. <br /> .pump me made! Yes: Ne ❑ If yo,by Whom? i-o—k :a1�v 11 Mod std Ca i • 7 S3 5 <br /> E: eak.,min.with ft,drawdown after his. SIGNED] <br /> i emperatare of water 'lass a eh•mical analr_sit made? Yes ❑ No ❑ <br /> Was electric Jolt made of well Yes ❑ No ❑ If yes,.trach copy License No 210542 D1te 3-2 <br /> ' 19� <br /> Y?^i SKETCH LOCATION OF WELL ON REVERSE SIOE <br /> ?52 <br /> QWIi 188 [stEV. 0.661 0717!-7.0..72 JOY TRIP Or QZP <br />