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STATE OF CALIFORNIA .. v Do Not Fill In <br /> THE RESOURCES AGENCY .. ® 3 6 3 <br /> oBlGixA1 _ _r�� �1/�►+ DEPARTMENT OF WATER RESOURCES .. 0'8 <br /> Q Cth QLa%jjmr,,=N71A LO�.7 D G�Z� J 1 <br /> later Code Owe. 13752WATER WELL DRILLERS REPORT State ell No <br /> Other Well No E� <br /> (1) OWNER: S h SO�Q u I•^� �-OV^� . . 11) WELL LOG: <br /> _ ,,��GG <br /> lame -T8=- o. Total depth `160 r ft. Depth of completed well 410 <br /> ,ddress 17900 7,.'. Ln Formation: Describe by color,character,size of material,and structure <br /> Loff. Uaa:11f.. 0&0*i0 W*5 S TOD IsGiL ft. <br /> '2) LOCATION OF WELL: 3e t.®•• ' '� Clay- B=O.:ount.,Sen Joaquin(}{ p �Orwner's number.if any 600000�®22� � P$ed• B= CZa <br /> Township,Range,and Section 1 AI 811 Seri lip 22 2r�r•tra0?J I � SandyLt;,,' TYn � Cita. <br /> Distance from cities,roads,railroads.ece.AD =X•. 7 mi• S of where 3 56 3 Exitt1e' ben eta <br /> Atkins- Rd and Harney- Ln intersect. 5 6._'v 1.35 3 }34.tE. dark brn c1a <br /> I) TYPE OF WORK (check): M.o•01 5 5 Sgndz ben clay <br /> New Well 9 Deepening ❑ Reconditioning ❑ Destroying ❑ 145,,,,146-tBB k ' sand Pe Gxml Tr <br /> f destruction,describe material and procedure in Item 11. 1 . 168 4 Sgg& b3 T1 <br /> ;4) PROPOSED USE (check): (S) EQUIPMENT: T68 2112_r, Red b s <br /> Domestic ❑ Industrial ❑ Municipal ❑ Rotary ❑ 2 .2 2 6 <br /> .Irrigation K] Test Well ❑ Other ❑ Cable Im 21 2 . tis5 <br /> Other ❑ 213 <br /> (6) CASING INSTALLED: 2 <br /> STEEL: OTHER: If gravel packed a r7 <br /> SINGLE. DOUBLE ❑ v <br /> t' 3 <br /> rT <br /> Gage Diameter <br /> From I'u or of From To ' 't' <br /> ft. ft. Diam. Wall Bore ft. ft. a S <br /> 228 14!' T. 0 —C S , <br /> 2 68 2'r It it Ir 306 .•. G 9'RolCks &. clay <br /> Size of ahoc ur well rine: y R Size of travel: 3 - ay <br /> Describe joint <br /> (7) PERFORATIONS OR SCREEN: 5 <br /> Type of perfora6un or name of screenterm b3k. 2­4 <br /> 5 <br /> Perf. Rows ti9 <br /> From To per per Size C �? <br /> ft. ft. row ft. in.x in. S <br /> t r Ir tr 'Laf <br /> TQA 3 <br /> 7AV- <br /> sij. , brn n1 atr <br /> .�. <br /> (8) CONSTRUCTION: <br /> Was a surface sanitary seal provided? Yes CX: No ❑ To what depth r fr. <br /> Were any>enm sealed against pollution? Yes❑ No K If yrs,note depth of strata sta-inad to =3m-. Me 23aTe =11-ed. back to <br /> From ft.to ft. S <br /> Fru. ft. to ft. Wo .Completed 9 ' <br /> Method of sealing G WELL DRILLER'S STATEMENT: <br /> WATER LEVELSThis well was drilled :ender my jurisdiction and this report is tare to the best <br /> (9) : of my knowledge and belief. <br /> Depth ac which water was first found, if known 146T ft. <br /> ianding levy e r tf ' f - t ft. NAME <br /> v (Person,firm,or corporation (Typed or printed) <br /> Scandine level after perforating and developing J' Et. <br /> - WELL TESTS: Address <br /> ump test made? Yea ❑ No ❑ If yo,by whom? <br /> ..J: gal./min.with '" -ft:drawdown after hrs. [SIGNED] <br /> (W41 f Driller) <br /> Tempera We of water Was a chemical analysis made? Yes ❑ No tty <br /> Was electric log made of well? Yes ❑ No If yes,acach copy License i�0.2 •� Dared A r 1973 s 19_ <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE �f'{�.;+':t::i= LOG <br /> Fiazei Code Sec. 1;;752 <br /> .,, i.- n n <br />