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LOCATION NOT CHECKEQ <br /> ORIGINAL WATER WELL DRILLERS REPORT Do Not Fill Ix- <br /> AN Original,Nplitate and Triplicate with the (sretionr rare,7077,7071,Water cede) No 8518 <br /> 'WATER ATER POLLUTION � <br />' <br /> STATE OF CALIFORNIA State Well No = _CONTROL BOARD Na <br /> (Inert eppropri.lr Mx xlrr) <br /> Other Well No�... <br /> 1) OWNER. (11) WELL LOG: <br /> Name ALICE AATR]{S Total depth It <br /> Depth of completed wall 130 it <br /> Address P. 0• Box 10 Formation Dis"4e by"Joe,th-drin,TO;t <br /> rn.�rl�,orf tl.rrtnrr <br /> it <br /> to J5 it P fid ']' <br /> (2) LOCATION•' OF WELL- iV B 51 <br /> coeaty San oaquin Owners number if any— Blue., 1l` <br /> R F D or Street No 4� 50 60 Grey Sand <br />' X/�.a- Blue Clay <br /> Gre Y SEnd <br /> Blue Clay, <br /> rrev Sand <br />' (3) TYPE OF WORK (check): S <br /> New well E Deepening ❑ Recondlnoning ❑ Abandon ❑ <br /> I If abandommenl,descrrbe material and procedure m Item 11 <br /> (4) PROPOSED USE (check) (5) EQUIPMENT: <br /> Domestic U Industrial ❑ Municipal ❑ Rotary <br />' Irngation ❑ Test Well ❑ Other ❑ Cable ❑ <br /> Dug Well ❑ <br /> (6) CASING INSTALLED. If gravel packed <br /> SINGLEt DOUBLE 7 Gape <br /> C. <br /> Diameter from to v'f`�~ 4 <br /> 4 P <br /> From p It to 86 ft 6 Diam [ Wall of Bore it it <br /> d' =r <br /> CGS <br /> Type gad srzc of shoe or well ring j Size of gravel <br /> Describe)ome j <br /> (7) PERFORATIONS <br /> Type of perforator vatd <br /> 1sIC33:e , <br /> $iu of perforsuoas in,length b <br /> Froin ft ft Perf per raw Rows per it <br /> (8) CONSTRUCTION. •- ��'�'— '�'��rs�`r;RE (Y�fi =.. <br /> Wu a surface sanitary atal provided? 0 Yea 0 No To what depth ft <br /> Were any Strata"sled a6siost pollution? 0 Yes Q No If les,note depth of strata <br /> From fr to It <br /> Method of Sealuig Cork starred 5-7_ 19 54, completed <br /> (9) WATER LEVELS: WELL DRILL£R•S STATEMENT <br /> Thrs well war drdled under my)urrsd,ci,on and 1brs report n true to the best of <br /> I Depth at which water was first fouad V'.L. 12 It my krwwLed t aced belwf <br /> Seaodsna level before perforatiaD ft NA <br /> ,tag level after perforating ft1 <br /> (Person firm or corps.rauon) 4Typed or pts+ted) <br /> Address <br /> (I 0) WELL TESTS: <br /> Al- <br /> VAN yiainy test made? ❑ Yn ❑ Ne if yn by whom? <br /> Yirldt gal/rano <br /> -4th it draw down after brs [sIGNEL] s,� Com» __ L » _ <br /> b7850 1•ru n.+Her <br /> psrature of,aur was.chemical.vialyua aaaea3 ❑ Y« ❑ Ns License Na.... <br /> 'Was eleetrie log tusk of wrIlr ❑ 7« ❑ No <br /> Y® •roar a 64 DOM 4u114 0 fro DWR FORM No 246 INEV a Oa? <br />