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STATE OF CALIFORNLA Do Not F,II In <br /> THE FtES00MCES-AGENCY k"ip xp <br /> ORIGINAL DEPARTMENT OF WATER )RESOURCES N9-'-_0^ O a <br /> File with owlt 1 <br /> WATER WELL DRILLERS REPORT State well No <br /> ' Other Well No " 17 <br /> (1) OWNER: (I 1) WELL LOG- <br /> T ] <br /> I�Ia[i1C T_ _ T A lea f- A <br /> �,$. otadepth it Depth of completed well ft <br /> ' Address Formation Describe by rotor rbereder stzr of melena) said 3oraeture <br /> it to it <br /> (2) LOCATION OF WELL. <br /> County San Joaquin Owners num6er tf any Tap Sol 1 <br /> Township Range and Stetson <br /> tt� <br /> Duiance from terms roads sada eu <br /> (3) TYPE OF WORK (check) <br /> New Well ICJ Deepening [] Reconditioning [] Destroying E] rid_ <br /> If destrsrhon,describe material and procrdnre:n Item I I <br /> ' (4) PROPOSED USE (check): (S) EQUIPMENT. <br /> 0-8 , Gravel <br /> Domestic ® Industrial ❑ MunlctPal ❑ Rotary <br /> Irrlganon ❑ Test Well ❑ Other [] Cable ❑ <br /> Other ❑ <br /> Xp— <br /> (6) CASING INSTALLED: <br /> STEELX OTHER If gravel Packed <br /> 1 26 <br /> SINGLE DOUSLE <br /> ' <br /> Gage Dtametcr <br /> Froth lo or of From To <br /> ft It Diam Wall Bore ft fc <br /> 7"185 Clay <br /> D:za of,hue or well ring site of travel Q <br /> m De,crs6r welded <br /> (7) PERFORATIONS OR SCREEN <br /> f ype of ptrtoe—oo ur name of screen <br /> .91 fit <br /> Irerf Rows <br /> From To per per Size <br /> fc ft row fr in x in <br /> 154 . 174 It <br /> (8) CONSTRUCTION: Water <br /> Wel,a aurtaee sin:tary teal provide -Yes- To what depth {t <br />' Were uny%rrJu,wird=gatnst pollution° Yes 11 No ❑ If yrs voce depth of strata <br /> tram <br /> It to ft <br /> 1•rom ft to fr Work started i9 72 Comptes 9*'27 t4 C <br />' tilethod a1,til,nx _ WELL DRILLERS STATEMENT <br /> (9) WATER LEVELS. This well was dulled under my jurisdiction and thn report is tare to the best <br /> Depth at which water was first found if knownfs of nu knouledgr and belief <br /> ,landing level 6efom perforating if known ft NAMEHennin s Bros . Well Drillina Co. Inc <br />' )tandtnt level after perforanng and developing {r (Person firm or eorporaaonJ (Typed or priared) <br /> (10) WELL TESTS Address 2500 W. Rumble Rdo <br /> s pump test made? Yes © No If yet by whom! Modesto Calif• 0 <br /> tial rmtn —h fe drawdown agree hes [SIGNELII <br /> Temperuure of water VV-s a chemtea[analysts made? Yes © ho (Weil Drr! <br /> Waa e(ecrnc log made of wells Yea N If yea attach copy1 #b�22 <br /> License No ..—D..d 1 <br />' SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 189 (RFV a 6e1 �1 <br /> Z5176 aao o ea rsoaf rRt t•do osr <br />