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Do Not Fill In <br /> STATE OF CALIFORNIA <br /> THE RESOURCES AGENCY N0g 554 <br /> ORIGINAL DEPARTMENT OF WATER RESOURCES <br /> Fife with DWR WATER WELL DRILLERS REPORT s"" w�u �U-�N E 4-!� <br /> r <br /> � Other Well ;�f�\ot / _ <br /> ( i) OWNER: (1 1) WELL LOG: <br /> rattle 'Forst drvrh !r- Dcprh of w p1r,rd-11 273 ft. <br /> Address Formation: Describe Ly rotor,rharerrrr,fa_e of nrarerruf,Jn!jrrurrurr <br /> (2) LOCATION OF WELL: 1}r5ry Clay <br /> i.vunty 0 tuber,if env 15 2❑ Sand <br /> Township, Range.and Sc-.. 0 63 Clay <br /> D.s a krusn cities,roads, no?rwds,eu. 6 67 Sand <br /> 67 133 Clay <br /> (3) TYPE OF WORK (check): 133 141 Sand <br /> New Well (5 Deepening ❑ Reconditioning D Destroying .14.1 169 Clay <br /> if destruction,describe material and procedure in Item 11. 169 179 Sand <br /> (4) PROPOSED USE (check). (S) EQUIPMENT: 179 205 C1a . <br /> Domestic ❑ Industrial ❑ Municipal ❑ Rotary ® 205 2 2 Sand & B i Grave l <br /> Irrigation ® Test Well C Other ❑ Cable ❑ 272 280 C1a <br /> Other ❑ <br /> (6) CASING INSTALLED: <br /> STEEL: OTHER: If gravel packed <br /> SINGLE ® DOUBLE <br /> Gage Diameter <br /> From I'u or of From To <br /> ft. it- Diam. W3II Bore ft. ft. <br /> +11600 50 72 _ 25n 28 <br /> r 1B❑ 2❑ <br /> Six ul r mril,n*: sir of__114 plate <br /> travel: <br /> 0-11 c win+ <br /> (7) PERFORATIONS OR SCREEN: F <br /> Cyp� f per 1„ 1u�.n, mr - e — 11a <br /> Perf. Rows <br /> hruto To per per Size <br /> ft. ft. row ft. in.x in. <br /> 231 255 <br /> 29-9 273 <br /> (9) CONSTRUCTION: <br /> Wa a+urfaee aanrra ry seal provided? <br /> Y,,Xj No 0 T.what depth 50 Fr. <br /> Wrr ­lyd aKzinsr p„d.tion+ Yrs ❑ No If yes,note depth of..rola <br /> From ft. c fr. Work'tarcrd 19 Compl,trd21 Jul 17 72 <br /> slrlh d i,reline WELL DRILLER'S 5TATEh1ENT: <br /> (9) WATER LEVELS: This teril wd te <br /> as drilled my jurisdi(-tion and Ibis report is trite lu the best <br /> °f my knowledge and belief. <br /> ueprh a wh�rh wa was f,rst fount, if k.— <br /> ...I <br /> nown.v,l hcf. perfnra g, it NAM. Clark Well & Equipment Co <br /> !undine [tori vd drveluwna ft. 4:rrr'an,firm,nr corpusuiun} tTrprd or panted} <br /> (lo) WELL TESTS: Address 2024 East Charter Way <br /> p�m,+ r'tmade Yr' ti.+ r_1 , Ifyr'.byuhn ? P G & E Stockton CA 95206 <br /> rai..�mrn.vich ft.d—doa,n al rcr hes (SIGNED] <br /> .n+prrature nl Water Was a chemical anal osis maJrs Yrs,,] No ❑ (Wel!Or'!�lrr^) �'7 <br /> Wa,e1rcvw IoK inadr ui veil? Yrs [ No ❑ If yes,arcveh copy ?6 6}!�_ _[}atCtj 4 July !9 2 <br /> License No. <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 1138 -REV 9.6a 3]119-979 +-6B Iota Taip AD 0.r <br />