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i <br /> LUGINAL STATE OF CALIFORNIA DO not fill to <br /> THE RESOURCES AGENCY <br /> He With DWR DEPARTMENT OF WATER RESOURCES No. 076256 <br /> r Intent M, WATER WELL DRILLERS REPORT State well No 25�7� -'•+�A_d <br /> t'ermit No or Date Other Well No.�7�E ' 4N�— <br /> 1) OWNER N,,,11e Central Pum (12) WELL LOG Total depth 375.ft Depth of completed well 370ft <br /> Address 1 601 Mono Dr• fn,m ft to ft Formitron (Describe by color charaLter size or rnatertai) <br />("mrit, <br /> t, Modesto Ca. `cp 0 - 1 Sand <br /> 2) LOS'ATION OF WELL - �� Clay <br /> . {See, utn rs Well ) 21 ..- 22San Owners Well Number �t <br /> WLII address if different fmrn above 22 2 Cla <br /> IwribhIPRange Sect4n allatance from Cities mads railroads fences etc C :Ev O an eca — ay <br /> Well No. 1) , Vanderl5ilt Circle38 - 5 <br /> 55 1 & samd streaks <br /> 1 - 1 Sand <br /> (3) TYPE OF WORK 165 ,9 18 Claysand s res S <br /> New Well g[ Deepeninf, ❑ 1 1 Sand <br /> Reconstrrtetton ❑ 1b7 — 0 <br /> Renmddnmmg ❑ qRO 5 — <br /> Hornzontal Well ❑ — 22 <br /> Destruction [] (Describe NZZQ and <br /> destruction materials amd — la <br /> procedures to Item f ASO <br /> (4) PROPOSED396San <br /> Domestic 33 <br /> Irnttctuui — 4 a <br /> Irxiustnaf ❑ 2 sand <br /> T Well ❑ — 6 Blue cls <br /> Shu 0 — and <br /> Muntwp 370 y Clay <br /> WLLL LOCATION SKETCH Other ❑ — <br /> 5) EQUIPMENT (6) GRAPACK — <br /> utary ❑ Reverse ] No Size — <br /> q <br /> C able ❑ Air © t <br /> er of bare <br /> ❑VILr BuLket © at O 70 — <br /> 7) CASING INSTALLED (BJ ERFORA S — <br /> steel j' Plastic ❑ Cc L t Type of pe nor cc of scree — <br /> Frotn To DiaG r F To <br /> ft ft 1" Wall ft -A <br /> s.z - <br /> 03 tta ci;ed et <br /> for S e - <br /> lac -- <br /> S) WELL SEAL <br /> Was surface b imttary seal provided? Yes No ❑ If yes, to depth 1 nnfr <br /> ere strata sealed aiamst pollution? Yes ❑ No D Interval-----------ft. <br /> — <br /> ethd of seahn Work start I9Pot Completed—..__. —I`� <br /> (1a) WATER LEVELS WELL DRILLER'S STATEMENT <br /> Depth of first water, if known ft This well uws drilled under pity turtadi`ation and this report is trice to fhL best of my <br /> tanding level after well compietto ft knou.ledge and behef <br /> 11) WELL TESTSp G & E ,�jIGNED (Weil Driller " <br /> Was well test mide" Yes No El If yes by whomo • • • <br /> Type of teat Pump Bailer 0 Air lift 0 NAM Hennings Bros . Drilling Co.1 lneo <br /> IDepth to water it start of test ft At end of les Y iso fiq� or c�r�tion (Typed or printed) <br /> tree1��tal/trun fter - ___ hours Water tempera Address—3 Pe1anG1a1� ���o C��j��� <br /> 1 analysts inadea Yes EJ No X If yes, by whom? City _Z-�_ <br /> citric log madO Yes C7 No If yes, attach copy to this report Lacense No_ d ��� Date of this report 2' 4—y0 <br /> r;WR 1813 (REV 7 76) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />