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i <br /> I � �C7��Q� r STATE OW CALIFORNIA Do not fflL lit ii@S with rJWR 'TV <br /> HE RESOURCES AGENCY �/�. 216086 <br /> DEPARTMENT OF WATER RESOURCES <br /> Intent No WATER WELL DRILLERS REPORT state Well No$',ol <br /> ermit No or Dnte��? = 7_ Other Well.o�� --- <br /> (1) O WNEM N,m le M iC IL I X rI�j (12) WELL LOG Total dept -_}t Depth of completer) wolL-8•C--Jt <br /> lddress 220Q Powill1 5T from ft to ft Formation (Describe by color, ehamrter, scar or material) <br /> T err v 1 J 1 e C A z! Q -10 F z n <br /> (2) L CATION OF WELL (See Instructions) 10 -37 Brown c 1 a <br /> I <br /> County, <br /> an loaquirt Owner'sWbllNumber Sob 37 -58 Sand & Blues clay <br /> - - - - , <br /> Well address tf dtAerent Frnm nbav <br /> off Sonora Sc , Stockton 58 -64 Sand <br /> Townahtp Rango Sector 64 -84 Sand & B 1 u 6 °e,Y a <br /> r <br /> Distance from titres roads, vu)ronds,fences,etc �E <br /> (3) TYPE OF WORK <br /> K <br /> New Well ES Deepening El <br /> See map attached Reconstruction Q E <br /> Retondttlaning ❑ �'' � (V <br /> Ilorzaonml Well ❑ '*a�A'e, - \ <br /> Destruction Q (Describe <br /> destmzctian matonals and <br /> proeedures in Item I$r - <br /> (4) EROPOSED <br /> Domestic <br /> Industrial ❑ <br /> I 4 <br /> to <br /> WELL LOCATION SKETCH °+moo p1bMT O 111 L O r <br /> (6) EQUIPMENT (6) GIiAVL CIZz �� ��� <br /> ,"� ) 0 , <br /> Rotary ❑ RLverse [3 a Ste�s1��y Ilio Saxe "' <br /> Gnbte �] Air [] Dia�rZglboF bar f t ~� 1�ti�j <br /> ❑ 5 80 `1 1- <br /> Other 3kP' d fron — - <br /> (7) CASING INSTALLED, {A) P$RIORATYO?iS� <br /> Steel 17 Plistto ❑ con rat t t Typo Of Perfd tf or s xb of screen �l <br /> From To Ikla Ga ear €t <br /> `.�Frut�11% L`...,.'TO � 1�t <br /> ft €t f( m Wn]1 IZ <br /> 2.9 0 't F <br /> (9) WELL SEALt ~Z <br /> Was surf-aco sanitary$eal provided? Yes p, No C) If yes, to deptb._�t <br /> Were strata soiled against pollution? Ye C) No ❑ intervn� ft <br /> Mahod of sealing-C u n C r e t e lb e n t o n i r_e �..� Work started Y B Complete 10 <br /> (10) WATER LEVELS i f i WELL. DIULLER S STATEMENT <br /> Depth of Srst water, if know �"'�^r bis toil) was Lf a under mu funs f n arjrt report fs true to the best of mp <br /> Standing level alter well carnpletio � ,�n{ledee and <br />' (11) WELL TESTS D e <br /> Was well test made? Yes Q Nc<Q. If yes by ,)loin r, <br /> 'Iype of test Pump 11 Haller QAhtt QA • 1 aRlO n d t O e 11 r z 1 II C <br /> Depth to ,valor at start of test_ it And af�t'es 9r t is 1, (Person Ann, or corporation) (Typed or painted)- —— <br /> rAgile„ 10556 Petunia Lane <br />' e daI/anfn nFtar hours 1}ra er temp$fr 1 r j <br /> orj&l f fi ^ I ct _ rQPa1 o Cedro CA nnagysis made? Yes El No;� If yes, by ,hgPii'VIetne Ion mala? Yes 0 No;j3{ If yes, attachacoj3r to'051s report ns No � 12406 Dnto of ehra repay 12-4-67 <br /> ti <br /> 13WR 108 [REV 7 761 IF ADDITIONAL SPACE lI"eN[v050EO�`05r! X tONs1ECUTIVELY NUMBERSE) FORM <br /> r <br />