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Depa=-X,ent of Water Resources <br /> Central DIs tract <br /> Sacramento , CA 95816 <br /> Attention.' Xr. Andy Lee <br /> I cert==fir that I am the owner of the well located at <br />' 22 cast larket Street Stoc'<ton_._ San Joaquin <br /> Street Address City and County- <br /> Assessor ' s Parcel Nju=er Townsn=p, Ra=ge, ..anc Sect=cn <br />' (Use the back of this shee_ to add any other info=atyon that wculd, <br /> help locate the well , or to draw a sicetc n of the well locat,on. I:;cor- <br /> mat=on may include subdivision and lot number, well nu:rher of .fes=gna- <br /> t=on, or a physical description of t ne location of the proper Ly �:I <br /> relat-on to other streets , landmarks , etc. ) <br /> The well was drilled for City of Stockton <br />' Name of the original owner <br /> I?72 By Unknown <br />' Date or Year Drilled Name of water Well Driller <br /> S request a copy of the Water Well Drillers Report for LLv well �e <br /> released zo <br /> ll1 T T i an Channell <br />' Name <br /> 14ater'lork Corporat-ion <br /> Company or Consu_.tant <br /> 1710 Flazn Stree_ <br /> Mailing Acdress <br /> cscalon, CA 95320 <br /> City, State , and Zip Coce <br /> - "Signature (Owner of Well) <br /> City Nall <br /> Address <br /> Stockton , CA 95320 <br /> City, State, and Zip Coca <br /> "Date <br />