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ORIGINAL STATE OF CALIFORNIA Do not fill in <br /> THE RESOURCES AGENCY <br /> F with DWR DEPARTMENT OF WATER RESOURCES NO. 053739 <br /> R Intent No NATER WELL DRILLERS REPORT btate well No <br /> i Parmit No or Date — w /1/�`r Other Well No <br /> 0,( ) rr��//�� <br /> ( 1) OWNER \P.0 . <br /> 7Nelson Ready Mix & Concrete (1`3) WELL LOG Tot it deptli22_nn�� rr]] o <br /> ft Uepth of tonipleted welt l ft <br /> tddres r •0 • Box 545 from tt to tt Formation (Desenbe by color eharuter Size ar rnttenal) <br /> City Ripon, Ua. Zip 0 - - 2 Topso it <br /> i?) LOCATION OF WELL (See instrucbom) 2 - 2Clay <br /> Gruuty uin Owners Well dumber 20 29 Blua, els <br /> �Lell address if different from above 29 11 BlueQ's and <br /> To-riship RangeSectio — 2 Blue ;�,y <br /> Distance from cities roads railroads fends etc 20�-9Navy Dr. 2 2 — iue sancL <br /> Stockton - 126 clay <br /> 12b car se sari <br /> 134 ; BTue clay <br /> (3) TYPE OF WORK and <br /> New Well IX Deepening ❑ Ue C a <br /> Reconstruction ❑ <br /> Reconditioning ❑ — j <br /> Horizontal Well ❑ ',` — <br /> Destruction ❑ (Describe 2029\-1— 202 'Blue els <br /> destruction materials anti <br /> procedures in Item 12� 202 - -21 " Sand - <br /> (4) PROPOSED USES 214 - 221 Blue- cls <br /> Domestic C Z21 — 2C- Sand <br /> Irrigation ❑�2� — 270 Gla <br /> Industria] `�� <br /> 'fest Well Cl <br /> Stock♦\ — <br /> blunrCiptl <br /> WELL LOCATION SKETCH ` Other ❑ — -- <br /> 5) EQUIPMENT (6) GRAVEL PACKWoodaand — <br /> Rotarti ❑ Reverse Yzs Vo>Q> Size � ' d — <br /> Cihle ❑ fir ❑ 1 <br /> � CEta�eter of bore <br /> Other Bucket — <br /> ❑ Cl❑ P� ked from �.,_.tot- <br /> CASING INSTALLED (8) -PERFORATIONS — <br /> ,louvered <br /> Steel Plastic ❑ Cunt,rete LF. Type of perfrxatiha or size of screen <br /> From To ,DIA Ga�*��r Froin\\ �� To fl Slrxc' - R <br /> ft ft_ ' ` in Wall i ft\-\ZZ\- ft - <br /> O 2 0, j `t3/16 1 gf - <br /> T� <br /> f 9) WELL, SEAL � N <br /> Wis surfice +amtan sea[ provided' Yes %o 2 if tes to depth 50 w <br /> %Nom trata sealed aitainst pollution' lies 1--) yn -�] Intcnml Ft — <br /> tl,Lha d of sc-lm Ve—k start19 CompletP*I 18 <br /> (10) WATER LEVELS WELL DRILLERS STILTEMENT <br /> Depth at first water if known ft Thus u.cf1 was drilled under my iunsd rtion (an :is repurt 15 true to he best of mq <br /> btaudui4 level ifter well completion ft knowledge and beh / J <br /> (11) WELL TESTS s,uNk.i) <br /> W1% well test made' Yes)e No ❑ If ves by whimmi Hennings L- (Well Driller) <br /> Type of test Pump ❑ Sailer ❑ Air lift ❑ N 1tfE Hennings rigs BI'ros * Drilling CO. 2Inc, <br /> to water at start of test rt �t end of test ft (Person, firm or corporation) (T3Ped or printed) <br /> 1 840 .address 1, Ave ,Y e <br /> + al/mut after hours eater teniprrature � 9 X13 5d <br /> .\ 141 tnalvns made? Yes V No Z If les b) nhomi City P <br /> electric tog made' Yes ❑ Nh o If tea itttcLopy to this mpurt LLLeliae NO Date of this repo —'6-17 <br /> DWR t88 (REV 7 7e) IF ADDITIONAL SPACE= IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />