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' r STATE OFT CAUFORNiA <br /> (ORIGINAL 2 o; Z THE RESOURCES AGENCY Do not f:Id in <br /> File with DWR <br /> DEPARTMENT O!' WATER RESOURCES <br /> WATEi% WELL DRILLERS REPORT N0. 28613.3 <br />' �tice of Intent No, State Well Na -_ <br /> Local Permit No.or Date Other Well NA <br /> (1) OWNER Name Gi!iy of Trac (12) WELL LOG Total depth ft.Completed depth ft. <br /> Address 560 Tracy Blvd. from ft, to ft Formation(Describe by color character size or material) <br /> cityaey, CA zfP <br /> 860 -865 Brom Clay S(IcIW WSmall Stringers <br /> (2) LOCATION OF WELL(See Instructions)�4-'o - of Crave <br /> m - Grave W ay Lagers <br /> County Owners Well Number <br /> Well address if different from above 872 -885 Broim Clay Il Trace of Grave <br /> Township flange Section 885 -895 Grave Rocks & Clay Some ar <br /> Distlnce from cities,roads,railroads,fences,etc. — tringer <br /> 895 -912 BroT,vm a t3 y <br /> 912 -92Z av me lFocks <br /> - rav rOFln ay <br /> (3) TYPE OF WORK oXM W <br /> New Well © Deepening ❑ 932 9JU Oim ay Hard Stringers <br /> Reconstruction p P r ay Layers <br /> Rewadittomng ❑ 964- Brom QWr I1/Gravel Strj_ngers <br /> I orizontal Well HardATI- S <br /> Destruction 0 (Describe — Brqiqk1_-q1,AVU/Hard Stringers <br /> destruction materials and pro- B & IIEO Gravel & hard <br /> I ceclures in(tom l2j _ O trarig <br /> (4) PROPOSED US <br /> Domestic <br /> 0- � 1 6" X " 6nductor <br /> Irngat,on aC k Pipe Gravel Tube <br /> Test Well el [) r 2" Ound�n Tube <br /> Test ❑ 0- 250 /-:Qrout eal <br /> Muntci ❑ O <br /> o er C0 -r1i W X-5/16" BlankMg <br /> Gas <br /> WELL LQCATiON SKEICi[ e�be} 490-k& 16" X 5 16" Ail no .070 <br /> (6)EQUIPMENT kv�. <br /> Av cg 9,89x­9916" X 5/16" B arllt CasZn «nth S E H, <br /> Rotary ❑ Reverso ❑ �dr <br /> Cable ❑ Air ❑ o[bore <br /> other © Buck e cw F, — <br /> (7) CASING INSTALLM (8) PER O TI — <br /> steel ❑ Plastic ❑ Ty of ori or&Q0From TGageor ft. f I Wall <br /> (9) WELL SEAL = <br /> Was mufacesanitary sealprovided? Yes ❑ No 0 If yes,to depth ft <br /> Werestratasmledagainstpollution? yes© No❑ Intcrval it. — <br /> Methodofsealing Work started 19— Completed 19— <br /> (10) WATER LEVELS_ WELL DRILLER'S STATEMENT <br /> Depth of first water if known ft <br /> Depth of firstk-ewater if k completion This well was drilled ander my Jurisdiction and this report is true to the <br /> [t. hest of my knowledge and belief <br /> (l)) WELL, TESTS Signed <br /> 4Yas well test made? Yes ❑ No 0 If yes,by wirom? (Weil Dnlil <br /> pc of test Punip ❑ hailer ❑ Air lift ❑ NAME livers Bros. Well Dral7 In Inc. <br /> pili to waterat start of test ft At eud of test if <br /> (Person(lieu or corporation)(Typed or printed) <br /> csciiarge.---.�g,%Vmtnafter hours Water temperature Address_f} 50 E• Te'tl'ey RI Vd. ..,.._ . <br /> Chemical analysts madc? Yes ❑ No❑ IF yes by whom? airy i nford, CA ZIP 93230 <br /> Was electric log made Yes ❑ No ❑ If yes,attach copy totlinre rt License No 548214 Dateof this report 3-16"89 <br /> DWR las iRKV i2-et3l IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NumE3ERED FORM 86 96355 <br />