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ORIGINAL STATE OF CAUFOAN1A Do root fia 17a <br /> Fila With DWR THE RESOURCES AGENCY <br /> DEPARTMENT OF WATER RESOURCES No. 47941 <br /> N,:tire of Intent No. WATER WELL DRILLERS REPORT Stare well No. <br /> !L it.No- or Dale_ 77-532'wOther Well No. + <br /> (1) owNER: N,m {12) WELL LOG: Total depth 160 fr• Depth of completed we11156 ft. <br /> Address 2$26 Chrisman Rd• fano ft. to k. Formation (Describe bs_- color, character, size or materia]) <br /> t,n- Tracy, CA . ,in o- ToR s oil <br /> (2) LOCATIQN OF.WELL (See instructions): - 8 Gravel <br /> s,cunt, a n a o uzn owner's well Number $ 17 Play <br /> Well address if different from above 17- nd & gravel <br /> Township RaubeSe w <br /> 3 n <br /> Distance from cities, roads, railroads, <br /> znne `H 2 mz e - an grave <br /> west can a itd. north sille 60- la <br /> \_ ravel_ <br /> 132- 1Clay <br /> (3) TYPE OF WORD: 1 1 2 Sand & gravel <br /> New WellL Deepening ❑ 14,N150 Gla <br /> Re,corsstruction ❑ 150-1,M'I rave 1 <br /> Reconditioning ❑ 15 5-i, a <br /> Horizontal Well ❑ <br /> Destruction ❑ (Describe - \� <br /> destruction materials <br /> procedures in Item <br /> (4) PROPOSED <br /> Domestic <br /> Irrigatinn.f� `�� <br /> Industrial �\ \ ❑ <br /> Test Well \\ � ❑ _ <br /> Municipal`) Q• ,� \-i <br /> WELL LOCATION SKETCH Other ❑ -'�`1\% <br /> (5) EQUIPMENT- (6) GRA E PACK: <br /> Anton ] Re,erse ❑ Fes X NoEn Size _ <br /> cAlle ❑ Air ❑\� �?Teter of bore _ <br /> Other ❑ Bucket ❑ ackZ[Lfrom - <br /> {-) CASING INSTALLED;;:•• (8"ERFORA-iTON5:hand Cllr, - <br /> Steel ❑ Plastic gJ Ct\ et Type of pe{fnmtiun or-3ize of screery <br /> FroinTo- <br /> -JIDi.. G'M: br Front`- i To;` in. Fall ft. - <br /> 15 1 W 1 15 <br /> (9) WELL SEAL: �was surface sanitary seal prodded? Yes CX No ❑• If yes, to depth 5.0 1 ft. <br /> Were strata sealed against pollution? Fes U No ❑ Intercalt. <br /> Methrxl of sealin• Work start 19=;L7= Completed Sy <br /> (10) WATER LEVELS: WELL DRILLER'S STATE\IEtiT: <br /> Depth of first water, if knn ft. This urell icas drilled tinder mid jurisdiction and this rennrf is lrtre to the best at my <br /> Standing level after well completion {t. knoulcdYc d belief• <br /> ( 11) WELL TESTS:_ - _ SIGNED - <br /> Was Nvell test made? Yes r" Nr• if yes, by . hon? «'ell Driflerl <br /> Type of test Pump ^ Bailer ❑ Air lift ❑ H nnin s Bros . Drilling Co. , nc. <br /> \A\IE g �7 - -- <br /> Depth to eater at start of teat ft. At end of test, kP s c rrat' n Typed or printed) <br /> Address 3 52 5' <br /> r& dae �te. <br /> L�ischargc� nal!mirt cher hours Water temperature Modesto, <br /> (.h rnah-sis made? Yes u Nam' Sf pis, bg whom? City • i <br /> ,'iv log made? Yes ❑ N if�•", attach hr this report Liceur No. Date Of this report_ 0^ <br /> Dw.. ,e9 tntiv.77a7 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM .rst4•9507.78WMQUAD CUT ose <br /> ate � <br />