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ORIGINAL STATE OF CALIFORNIA Do not fill in <br /> THE RESOURCES AGENCY <br /> Ile with DWR DEPARTMENT OF WATER RESOURCES N0. 096932 <br /> of Intent No WATER WELL DRILLERS REPORT State Well No �++ <br /> Permit No or Date gOtherWall Noi��1 �r <br /> (1) OWNER h,m Ralph Hayes & Son Inca (12) WELL LOG Total d,th�l.Qe�ft Depth of completed weI€ BQ�t <br /> Address 1075 W. Clover R • From ft to it Formation (Describe by color, chancter size nr matesial) <br /> city racy, a. _ zip 0 - 2 Topsoil <br /> (2) LO-CATION OF WELL (See instructions) 2 - 68 C la <br /> Cormty r. i claqu n µpyyners Well Dumber 6 Fi sand <br /> Well address if dLfFerent from above / - 165 C a <br /> Township ttangeCectto - ine �i <br /> d 10.7 <br /> u€5t ien 00 i°We'st�''ofTracy etc <br /> vd . , northW. Clover Rside - ay <br /> (3) TYPE OF WORK <br /> New Well Q[ Deepening f3 <br /> Reconstruction ❑ <br /> Reconditioning Q - <br /> Ne <br /> Horizontal Well 0 - <br /> Destnictton a (Describe <br /> destructfou matenuh <br /> procedures r Item - <br /> (4) PROPOSED - /n .� <br /> Domestic J <br /> Irr[t(ition , ❑ <br /> Industrial Qf <br /> T Wel] <br /> Six <br /> Munfctp - <br /> `V1rLL LOCATION SXETCH Other <br /> (5) EQUIPmEN'T 16) GRAV L\ ACKI R 0 <br /> Rotary �}` Reverse © . Nrk[] S€z <br /> Cable ❑ Air ❑ \ Deer of bore - <br /> Other ❑ Bucket 0 aE'Itec�(m - <br /> (7) CASING (NSTALLEDt (tl) kAFORA I� � - <br /> Steel Cl Plastic Co r to Type of par 1 ar\sres of scree - <br /> Frorn Tn Dla (; e.or Fr To <br /> ft It n Wall ft. ft r - <br /> 0 8 0 1 60 0 , c' een <br /> (9) WELL SEAL " - <br /> Was surfltce sanitary seal provided? Yes t No p If yes to depth ft <br /> Were strata setled against pnllntion? Yes No ❑ Intarval Ft <br /> Method of selling.- 1~ �O Work startc 19 Complet 19 <br /> (1D) WATER LEVELS. WELL DRILLER'S STATEMENT <br /> Depth of first avater, if known it This well tens drilled under m1 pltisd ction d th+t report is trite to the best of mp <br /> Standing level after well completion— ft knowledge and b of �t <br /> (11) WELL TESTSt SICNED r CF �l�` /7r:Ct:�fa l�(-Pj' <br /> Was well test made? Yes 0 No [X It yes, by whom? IWetI Driller tT�—� <br /> Type of test Pump 0 Bailer❑ Air lift© Drilling.. Cao. a In -.- <br /> 1vnM� H$Y1n-i.n�s Bros.,. �._� <br /> Depth to iviter at start of test—ft,ft At and of test_. ft lie on firm or co�°VIM) (Typed or printed) <br /> hours Nater tempera Addy 1525, Pelandale. AVey c <br /> rge _ �gallrnln after.„,,., Modesto, <br /> �-t u <br /> cal annlysis made? Yes ❑ No If yes by whom" City Modespto Ca• ip <br /> Wes electhc log madeP Yea [) No If yes ntt�ch cony to this report Liceasn No 29043 ate of th[s repo rt.�-t -`�v- <br /> DWR 188 MEV 7 701 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIV0..Y NUMBERED FORM <br />