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ORIGINAL STATE OF CALIFORNIA Do not fill Olt <br /> R TME REsouRCES AGENCY �{ �j{� n <br /> File with DWR nnL DEPARTMENT OF WATER RESOURCES No. 12 9 4 3 0 � <br /> *,brmltl <br /> tNd:l 159643 WATER WELL DRILLERS REPORT State Well No No.or D( r Other Well No. <br /> b <br /> MM ep t.75epth of completedw 1. <br /> k <br /> Add res from It, to ft. Formation (Describe by Calot, character, size or materinJ) 4 <br /> City- Escalon, CaI f. ztp 25 Sand <br /> (2) LU ATIQN OF WELL (See instructions): 66 Sand and clayla erS i <br /> County Ian_ JoagUZn . Ownees Well Number 66 - Sand <br /> Well address if different from above 77 - 110 Grav <br /> n {z� � <br /> Townshtp 2 S Rartga Sectio.+ 110 - 12 Sands ra '�e <br /> Distance from cities,roads,railroads,fences,etc 23858 S• Manley O8 - <br /> n <br /> 125 = 134i <br /> 13T-- ana grave <br /> (3) TYPE OF WORK: <br /> r C New Well dC Deepening ❑ <br /> Reconstruction ❑ - I <br /> Reconditioning ❑ <br /> Horizontal Well ❑ <br /> ' Destruction 0 (Describe <br /> destruction Mat""IS a <br /> Procedures iA Item - <br /> (4) PROPOSEIy — <br /> mI <br /> PP Aoestfe <br /> �f( <br /> Irrigation� <br /> Industria] ❑ <br /> ti S A ra `ll cover was installedl <br /> Municip <br /> on- 1 and I am no <br /> WELL LOCATION SKETCH \\/)Other ❑ res or any altering or <br /> (b) EQUIPMENT: (B) GRA PACK- mom g o e Sea or casing. <br /> Rotary M Reverse [I No Size <br /> kl <br /> Cable 0 Air ❑ i or of bora 0 ]� t, - ! <br /> Other ❑ Bucket ❑ <br /> (7) CASING INSTALLS (B) RRF'O Utr <br /> Steel❑ PlastEc Co &tl- <br /> From <br /> Type of pe n or a of scree <br /> To Dia. C F*16.,F <br /> TQ <br /> ft. It !n. Wall ft <br /> 0 i <br /> (9) WELL SEAL: ���� <br /> Was surface sanitary seat provided? Yes;-4 No [3 If yes, to depth-5-0—ft. <br /> Were strata sealed against Pollution? Yes 0 No <br /> 542 <br /> Method of sesurc, Cement Work ifl Completes 170 <br /> (10) WATER LEVELS: WELL ]DRILLEA'S STATEMENT: <br /> Depth of Srst water, If kno This toefl ours d under jiubdiction t s epo ae to the best o/m? <br /> Standing level after well completlar� 0 it. !t-ot°Jeds?t b <br /> (11) WELL TESTS: SIGNED <br /> Was well test made? Yes 0 No 0 If yes, by whom? (Well Driller) � <br /> Type of test Pump Q Bailer Q Air lift❑ NAME- PanerO' all Dril.lin9 1nC <br /> Depth to water at start of test_ ft. At end of tear ft (Person,flea,or corporation?(Tykretl or printed) <br /> Dt- arge hal/min After tours Water tempera tur Address_.,,., � f R X10 E. Lone Tree, Road <br /> Road <br /> 1 analysis made? Yes ❑ No ❑ If Yes, by Whom? Clty�qq��kdaJ e Calif. �� <br /> as elec5178 <br /> tric log made? Yes C) No [} If yes,attach copy to this report License No- JJ l�• `i nat�vf this repor l <br /> i <br /> DWR 1138 tnsv.7.rsr JF'A13DITIONAL SPACE 15 NEEDED. USE NEXT CONSECUTIVELY NUMf31 RR 3•Fi gRM <br />