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ORIGINAL STATE of CALIFORNIA <br /> ' THE RESOURCES AGENCY Do not�1�ileaJ� nt DWR DEPARTMENT OF WATER RESOURCES No. 180176 <br /> ' <br /> i-- Intent No WATER WELL, DRILLERS REPORT ermd No or pate Stats Well No <br /> 1L� <br /> T l� Other Well No <br /> WNER <br /> ONam WELL LOG <br /> Ada 1111 139th Avenue T° Rep 3�rr Depth of completed wel 3�ft <br /> from ft to ft Formation (]Describe by color, character, size ar matexui) <br /> city San Leandro CA. p 945 78 - 0 <br /> (2) LOCATION OF WELL _ moi st v course-v fine <br /> o�nt�_Sart_RIQ�f7L]n eol_Int (see s s1 silty, v. loose sub- <br /> all <br /> Owners Well Number - 1 no odor <br /> �4all address if different from above 14-0- 15.0 <br /> ' Township— 0&.S —Range—4' E Mt3° _ SrOWI1 `tdr cls S1. salt <br /> Distance from reties roads railroads fences etc 15-0- <br /> 5.a- 18.� compactecT,.,,no odor <br /> awn, sl: moist r V. coarse-fiz>� <br /> ' A sates sub-angular, sl.no r compactec <br /> 8' ' a tl brown saturated med, <br /> ' fs1 TYPE of wosx <br /> New Well j7 Deq—u g ❑ ye fa 53 1t Sub- <br /> MW$ Rero�an�on ar sl. can acted no odor <br /> ❑ 24�31.5L <br /> 0- ->brown saturated silt <br /> MAi14T1E c A \ Reca>ydipon,>ig n ♦ medium dense no odor <br /> - JHorizontal Well , '7brown saturated ►rled1ur11- <br /> 1,.111 1 �Kn�� - v fine s-and sl. salt sub- <br /> NOT procedures in Item lay angular. s�1 tl cam acted b- <br /> a (4) PROPOSED USE - odor p <br /> Domestic 31.5_ Total Depth of Borehol <br /> Irrigation p _ <br /> ' Industnel ❑ - <br /> w Test Well .1:1 <br /> Stacie �D _ <br /> Muroclpal 0 <br /> _ WELL LOCATION SKETCH Other <br /> 131 EQUIPMENT (fi! GRAV-L PACK i on grey - — <br /> Rotnir [ Reverse ❑ Yes ® No L] Size_ - <br /> Cahlr L, 8 i Air ❑ Dramne:ter of bore 8 <br /> Other [�'[ Bucket Packed fmm, -11-5—_to- <br /> i <br /> f7) CASING INSTALLED (8) PERFORATIONS - <br /> Shtl 1l Plastic a Concrete ❑ Type of perforation or sur of screen _ <br /> Fm m TO _TO Gage-or From,, _ To Slot <br /> ft in ft ft- size _ <br /> .r <br /> (9) WELL SEAL <br /> ' "Ls riirfaCe sawtary seal provided+ Ye=a ($ No if yes to depth. ],I-a-5 _ft <br /> Were strata sealed against poAtnftou7 Yes g] Yo Intezv <br /> Method of sealia <br /> 19 Complet <br /> (10) WATER LEVELS Work start 19 <br /> Depth of first water if known-_Lal WELL DRILLER S ST-kTEIMEN'T T <br /> Standing level ,rfter well cornpleho _ k j well t4ea dnlled ender my hirers{rction and the, r <br /> -- --�_ ft led{Ie and spare n trzz, to rhv nest n/ my <br /> (11) WELT. TESTS - t � slov�p <br /> Was veli test made' Yes N❑ '-' If _ / <br /> y� yes by Whriai� 3 rl <br /> ' Tfpe of test Pump h Bailer " ' lift <br /> G �I w {We <br /> airt NAME C/ i <br /> Depth to water a stars 'f twct _-�� �„u k rest__ J-t I <br /> r (Pe n fl mrpo ; Ped nr prustedl <br /> Me—-L.1{a1 ruin tftgr __-hotu� �\ater temperature— � Addrem I <br /> .i aaelYsa made Yrs 01 v L if ves by whomr_,S(:.Ci 1:'UG' City ` _Zip �C'�j 9C`�Was electric log mndr� Yes ('� Nn If ties attrch coPY to thts report ti license No - �3 �d �- <br /> ate .if this repo <br /> nww ise isty rye IF ADDITIONAL SPACE 1S NEEI3ED USE NEXT CONSECUTIVELY NUMBERED FORM <br /> s <br />