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i <br /> ,C'�aA Yti i <br /> T4p STATE OF CALIFORNIA <br /> Do Not Fill In k <br /> .may.,,,` ( �u•ta ��•#i I <br /> G?p �y';3i THE RESOURCES AGENCY �7O <br /> A FltfW Ith�h PWR �Go C0 DEPARTMENT OF WATER RESOURCES 1\'. 147186 <br /> 1�'9s,,,WATER WELL DRILLERS REPORT? 5sase Wel!No0 <br /> UJ M Other We11 No , <br /> (1) OWNER: (11). WELL LOG: <br /> Namet <br /> 1`fibert ;{. Vermeulen Taal depth 1 4 '`��1' 1t. Dtpthofrvmpleted.rfl) 184 (t. � <br /> Address <br /> Q Box 2 Fotmaeiox:Dnrri6r by color,rberertrr,tizr of nerJnlal,and rfraetprt � <br /> RLP-onx ga,11f, 95366 [t. ft. <br /> (2) LOCATION OF WELL; ry00 M 2 sand <br /> $, j <br /> c.-my U a u Owner's number.if In r7 2i1 C �+ Fila { <br /> Townibip,Ranee,tnd Station _ See,� 20 V 6 gland I <br /> Disraeer(wm eider,rwdr,nilrmds,etc, East-side Of s Ripon r" 92 cls I <br /> ROD, 92 M 100 sand ' <br /> (3) TYPE OF WORK (check): 100 I rQ b <br /> Naw Well;a Deepening ❑ Reconditioning ❑ Destroying 160 '-1 168 sand I <br /> if delhactionrdescribe tnaterialand procedureInItem 11. 168 ' — 190 brown clay <br /> (4) PROPOSED USE (check): (S) EQUIPMENT: 180 184 Band. ' <br /> Domestic ❑ Industrial ❑ Municipal ❑ Rotary ❑ <br /> Irrigation f] Test Well❑ Other❑ 1 Cable © 4 <br /> Other ❑ <br /> (6) CASING INSTALLED: <br /> STEEL, OTHER? 1f gravel packed <br /> SINGLE EX DOUet..E © t <br /> Gage Diameter. <br /> From TO or of From To L' <br /> ft. It, 1)iam. Wall Bore ft. (t. <br /> _ 0 <br /> - <br /> Slit of ahoy err well rin Lc8 shad <br /> Drstribe 101.1 U.i. ' e d 1 <br /> (7) PERFORA'T'IONS OR SCREEN: i <br /> ' <br /> Type of ptsformiun err m..of screen I <br /> i <br /> Pcrf. Rows <br /> From To per per Sizc <br /> ft. ft, row fr. in.x in. <br /> 1 <br /> (8) CONSTRUCTION: <br /> Was a wrface unieeq sal provided? Yet❑ No 0 To what depth ft. <br /> Were Any Acura xaled alpiesc pollution? Yes Q No❑ If Yee,mote depth of rtraat <br /> i <br /> From it.to ft. �r t <br /> From (t.to ft. Workttarred 12'-'23 1, C3.Completed12-2b ?975 <br /> .I <br /> Method of snii. WELL DRILLEWS STATEMENT: <br /> This well was drilled tinder my jurisdiction and Ibis report is ince Jo The best <br /> (9) WATER LEVELS: r7 of myAnoivfedgaand brilef. <br /> Depth a which water vas first!neral,if known 24 ft. <br /> Sundi.R level before perfnratia , 'f knenen it. NAME John hn i ane rd - <br /> Standing Ievel after t {Ptrwn,him,or eorpmasion) (Typrd or prinrrd) <br /> prrforaelm and dlvtlo in ft. <br /> (10) WELL TESTS: Address 11935 S• Vail Allen <br /> Val <br /> ¢EP tar made? Yea❑ No 0 if yet,by whom? Es ca on, ca • 95520i <br /> i <br /> 'Y1sId: edjlnin.with ft•drawdown atter hm fStaNto <br /> I <br /> TmnPeramse of water Was a chemical anal ria made? Yes❑ No❑ '} 120724 <br /> 1 �] 1wili Dr)ffrr) -I <br /> Wal eltetric lot?made of wall? Yes❑ No❑ If es,aetach eoP 11cen3e NO 20 f atec}^ ..._. 12-28 15 <br /> SKETCH LOCATION OF WELI.ON REVERSE SIDE <br /> ^.:' <br /> QWI3 18a isi2v.s•ae? �' �r.3Cs•e.Yal����(fjr osP <br /> I <br />