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IRIGINAL STATE OF CALIFOR N1A Do not fill in THE RESOURCES AGENCY ie DWR DEPARTMENT OF WATER RESOURCES No. 096932 ,,f Intent No WATER WELL DRILLERS REPORT Stite Niel] No _ I .al Permit No or Date Other%I,,]I No_Q F-5:1 u`i E � �'��C 1) OWNER -,1me Ra l h Hayes & Son Inc, (12) WELL LOG Total depth 1 8 it Depth of completed u el]-JaQft Idress 10765 W. C 1 ov e r Rd. from it to it Formation (Describe bi� color character size or material) ty Tranv. Ca. Zip 0 - 2 Ta soil ?) LOCATI OF WELL (See Instructions) 2 — 6 Clay Minty— San Joaquin Owners Well Dumber 68 - Fine sand r7 ell address if different from above / - Clay ,nnship Range Sectio I b5 - J ne sari rst ce from cities roads railroads fences etc ry • Clover Rd.. - ay OOt West of Tracy Blvd . north side - (3) TYPE OF WORK New Well X Deepening ❑ - Reconstruction [] - Reconditioning ❑ - Horizontal Well ❑ - Destruction ❑ (Describe - destruction materials and procedures in Item 12) (4) PROPOSED USE - Domestic _ Irrigation ❑ Industrial 0 - Test Well ❑ - Stock ❑ - Municipal ❑ - WELL LOCATION SKETCH Other ❑ 1 EQUIPMENT (6) GRAVEL PACK Roofing Stan h] Revene ❑ Yes x No ❑ Size able ❑ Air ❑ Diameter of bore��^^IT 1 " - her © Bucket E] Packed fmm '_L„ to 80 t - CASING INSTALLED (8) PERFORATIONS - el ❑ Plastic CX Concrete ❑ Type of perforation or srce of screen - FI0111 To Dia Gage or From To Slot - ft ft In Wail ft ft size _ 0 0160 0 80 screen - WELL SEAL as siirface s'imtan seal provided? les No ❑ If yes to depth50 it ere strata sealed against pollution° Yes ❑ No ❑ Interval it thod of sealm Bc t onite Work started 19-ftZ Completed 19 0) WATER LEVELS WELL, DRILLERS STATEMENT pth of first water if know it This well was drilled andcr nit/ plrisdiction d this report is trite to the best of TnV aiding level after sell completion 2n_ it knowledge and belief I) WELL TEST'S SIGNED- is hell test made" les ❑ No X If yes by whom" (Well Driller) pe st Pump ED Bailer C1 Air lift El NAME Hennings Bros. DrillingCoe Inc. PAW ater at start of test it At end of test it tjPerson firm or corporitvin) (Typed or printed) arge galimm after hours Water temperature Address 2 Peland le Ave Modesto Ca . r 6 ,cal anaEysis made' Yes ❑ No � If yes by whom? City-- '�-. _. _ Zip---__-1)�Q�� is electric log made-' Yes ❑ No If%es attzch copy to this report License No 290813 Date of this report .7-1 NR 188 (REV 7 76) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM