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ORIGINAL STATE OF CALIFORNIA Do not fill an <br /> THE RESOURCES AGENCY <br /> Ie with DWR DEPARTMENT OF WATER RESOURCES NO. 243233 <br /> of Intent No WATER WELL DRILLERS REPORT State Well No <br /> permit No or Date Z�573 Other welt NEo����� <br /> (1) OWNER Nan, Frank Mart (12) WELL LOG Total depth_`r' 5 I Depth of completed ww435j, <br /> Address = _ 3133 _Berry from ft to it Formation (Describe by color, character, size or material) <br /> qty. Tracy, cA 1,--25376 0 3 rOVS!211 <br /> 2) LO ATiOj1� OF LL See instructions) <br /> 0 s d clay <br /> Caunty <br /> an tJOaq� Owners %Veil Numher 0 0 rad <br /> Well address if ddferent from aboV 90 - 91 clay <br /> Toavnshtp -. �dng Sectia 91 _ — 5 sand & g' ar�iel <br /> Distance from ethos,roads,railroads,fences, ?fFl1 Street betwee C <br /> 6TH & 7TH Streets north side I-2 D--- 131 sa � <br /> ej a <br /> „J (3) TYPE OF WORK: <br /> Y� <br /> Now Well 29 Deepening ❑ <br /> Reconstruction 11 -- <br /> Recondetronlog Q Horizontal well D <br /> Destruction [] (Descnbe — <br /> destruction materials ap <br /> pnrccdures in Item I3`) — <br /> (4) PROPOSED 165 - <br /> Domestic j -- <br /> fm5ahoa <br /> incl0tstnai Q — <br /> ` <br /> ❑ <br /> T Weil <br /> Stock <br /> Muoecepa Q <br /> OF <br /> WELL. LOCATION SKETCH 'Other ❑ <br /> (5) EQUIPMENT: (e) GRA ACR / \ — <br /> Rotary §d Reverse ❑ 'M <br /> �0�,-- <br /> Other <br /> Cahie ❑ Air ❑ �N •r�r of boraaJ❑ Sucket ❑ f� 1 <br /> (7) CASING INSTALLED (8) ERFOAA bks <br /> Steel ❑ Pfasttc 0 Co ( Type of parf 0 or e of screen f <br /> Froth To Ca e-o Fro � Tv <br /> €t ft fit Wal! €t ft. / iZq - <br /> 0 13 5'-',W 160 115 s4 reen <br /> L _ <br /> (9) WET.L SEAL, Y <br /> Was surface sanitary seat provided? Yes 30 No ❑ If yrs, to depa-5-0 ft <br /> Were strata rolled against llutionP Yes (] Na Iotervnl Ft- <br /> Method of semen U]EntorVe tivork start Completotl —19 <br /> (10) WATER LEVELS WELL DRILLEWS STATEMENT <br /> Depth of first water, if know MY well roar deitfad under mu Jur4dicteon and this report is true to the best of mu <br /> Standing level after moil completion _ ft knowledge and b rel �l <br /> (11) WELL TESTS SIGNEEIL /t.L <br /> -� � - <br /> Wns well test made? Yes ❑ No X If yes, by whom? d (wen Driller #t <br /> Type of test pomp ❑ Bailer❑ Air left❑ NAME Hennings, B t DkA)IMing o <br /> Depth to tenter at start of At end of test_ rt e ) ( YPed cr punted) <br /> DWe ___`gal/men after' hours Water temperafuro Adde 735� � andavB,� <br /> anal so made? Yes a City 110Ctf:StoO GA11, r5 yt}Jip� T1 _ <br /> r p No 79 If yes, by whom <br /> n lair made yes �} Nam If yes, attach copy to this report License No 3i rata of this repo 11^10^ � <br /> r <br /> WR 18a 04Fv 7 7e) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVTrL+Y�IeI1��1�1" <br />