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i <br /> E <br /> I <br /> i ORIGINAL STATS OF CALIFORNIA Do Piot fill 113 � <br /> THE RESOURCES AGENCY pp�� <br /> . :"File with DWR DEPARTMENT OF WATER RESOURCES No, 054327 <br /> of Intent Nn. WATER WELL DRILLERS.;REPORT State Well NoIS . i <br /> Permit No,or Date 79-1074 other Well No. S 7-0H$2�- <br /> k: <br /> (15 OWNER. i <br /> i <br /> ttutt <br /> NamLOU: Total dept ft.Depth of completed %v*]Lji _Et, <br /> Address 2024 Gulfstream Drive from it. to ft. Formation (Describe by color, character, size or material) l <br /> City Modesto, CA Zip 0 - 12 sand <br /> (2) LO CA'TI N OF WELL (See instructions): 12 - 5 clay <br /> County a J uin Owner's Well Number— <br /> Weil <br /> Sari i <br /> Neil address if different from abov — C a <br /> Townshipsec <br /> Bong tio - 55 Sand <br /> D tnnca from cities, roads,railroads,fences,etc—i Mil eo Rd• <br /> F ---1 on 75 _ 2 Wqy <br /> 2 - Cl <br /> 900 - 11 sand <br /> (a) TYPE of WORKt 11 120 la <br /> New Well Lq7 Deepening❑ 12(Y\'\130 sai3d ' <br /> I <br /> Reronstnlction ❑ 130 — sh a and clay <br /> Reconditioning ❑ — 7 <br /> horizontal Well [� — <br /> Destruction❑ (Describe — <br /> destruction materials <br /> procedures in Item — <br /> (4) PROPOSED <br /> i�. Domestic ` <br /> Irrigation ❑ } <br /> Industrial ❑ — <br /> T Well [] = <br /> Stoc <br /> r Memel, <br /> WELL LOCATION SKETCH Other ❑ <br /> (5) EQUIPMENT: (6) GRABACK: — 7 <br /> Rotary ly Reverse ❑c ❑ No Size e <br /> Cable ❑ At, ❑ \ ` r of bore tt t <br /> Other ❑ Bucket ❑ lC Fin t r t — <br /> (7) CASING INSTALLLED: (8) ERFORA �4 <br /> Steel❑ Plastic a, Co a Type of pex t O\Ac of scree — <br /> Fmm To Dia. Ga C- rFr TD - ) <br /> ft. f in. Wall Et ft, < V�� <br /> 0 1 —1-60-- 19 9 c een - <br /> (9) WELL SEAL- <br /> Was ^ <br /> Was surface sanitary seat provided? Yea E� No ❑ If yes, to dept. — ! <br /> Were strata sealed against pollution? Yes ((�� �10 ❑ Interval -1t. — <br /> btethad of sea 1T4',— nite Work started I9 Completed lfl <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, If know ft. This well was drilled under nt1 inrisdfciion and this report Is Ince to the best of my <br /> SMnding level after well completio 42 ft. knowledge and Sefi . <br /> (11) WELL TESTS. SIGNED <br /> Was well test made? Yes ❑ Mo (�—If yes, by whom? t (Well Driller) <br /> Type of test Pnmp❑ Haller❑ Ai; lift❑ Inn`_ <br /> t I <br /> Depth to water at start of test ft, At'arid'of test_ ft C, P p J Ara" C rt i printed) I <br /> rRe�gaI/min after hours Water tempemhs Address �52 �eian+ a`� Den, I <br /> Weal analysis made? Yes f] Ifo R' If yes, by whom? 50 <br /> t tatty <br /> Modesto, <br /> Was electric log made? Yes 0 INTO IcIY If yes,attach copy to this report •t License No�o��S�ate of this xatFtr <br /> OWR lee (Rev.7.76) IF ADDITIONAL SPACE; IS NEEDED. USE NEXT CONSECUTIVELY NUMHER&D <br /> I <br />