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a�llL 2 7 1�6 <br /> ORIGINAL WATER WELL DRILLERS RiPORIO Do Not Fill yr <br /> File with DW, & } (Sections'7079,7080,7081,7081,Water Code) <br /> a. 0 44356 <br /> THE RESOURCES AGENCY OF CALIFORNIA �atcl{,S <br /> DEPARTMENT OF WATER RESOURCES state Well Noy, <br /> f � Other Well No <br /> (1) OWNER: (11) WELL LOG: <br /> Name Labor Camp For San' Joaquin CQ a Total deeds 20 1 it, Depth of completed we)( 320 <br /> Address Harney Dane Formadunr Dercribr by color,character,sire of material,and stracture <br /> 0 it j,.,12'* Sandy Clayft. <br /> (2) LOCATION OF WELL: 1211 20 Hard Ban <br /> County San JoaqUin owner's number,if any <br /> �211 Brom Clay <br /> ( <br /> Township,Range,and Section 6 100 ' Sand Gravel <br /> Distance from cities,roads,railroads,etc. <br /> 10011 1261 Brown 1 <br /> 12 144 Sand Gravel <br /> (s) TYPE OF WORK (check): 1 148111 San 1 <br /> New Well 99 Deepening ❑ Reconditioning ❑ Destroying ❑ 148 ! 154' Sand Gravel <br /> If destruction,describe material and procedure in Item 11. 154 1 6' Brgwn {til <br /> (4) PROPOSED USE (check): (s) EQUIPMENT: 31611 320' Sand Gravel <br /> Dolriestic 0 Industrial ❑ Municipal ❑ Rotary ❑ <br /> Irrigation ❑ Test Well ❑ Other❑ Cable ❑ <br /> Other ❑ <br /> (6) CASING INSTALLED: <br /> If gravel packed OTHER: <br /> SINGLE DOUBLE p <br /> Gage Diameter <br /> From To I or of From To <br /> ft. ft. Diam. Wall Bore ft. ft. <br /> 01 16411 10" 10 9V <br /> i <br /> size of shoe or well rii.,,. 4 x3 X 1 0 Size of gravel: <br /> Deseribejoint Welded <br /> (7) PERFORATIONS OR SCREEN: <br /> Type of pesfosatian or name of sercen <br /> Perf. Rows <br /> From To per per Size <br /> fr. £t. row ft. in.x in. <br /> (8) CONSTRUCTION: <br /> Was a surface sanitary sat provided? Yes 9 No d To what depth 50 ' ft. <br /> Were any strata seated against pollution? Ya Q Non If yes,note depth of strata <br /> From ft.to it. <br /> From fr.to ft. Work starred �'Gv ;1 , 19 6t ,Completed 19 GG <br /> Method of scaling WELL DRILLER'S STATEMENT: " <br /> 9 WATER LEVELS: <br /> This well was drilled under my jurisdiction and Ibis report is lrua to the best <br /> ( ) 1 of my knowledge and belief. <br /> Depth at which water was first found,if known 120 " fc. ®� f/ <br /> Standing level before perforating, if known ft. NAME /Jo"6- 'r7 le, / C ",0 S'lZ l C6 <br /> Standing level after perforating and developiag 99jisil <br /> ft. (Person,firm,oc corporation) (Typed or jitinled) <br /> (10) ILL TESTS: Address . 3 (3"jjkwo� <br /> ump test made? Yes{J No ElIf yer,by whomA a,-T eKe a sel L0 0/. <br /> gal./min.wills fc,dnwdown after 1 hn. [SIGNED] ..:-��-- <br /> (Weil Driller <br /> Temperature of water Was a chemical analysis made? Yes E] <br /> 0 No;0 <br /> Was electric log made of well? Yes Q No Ex If yes,attach copy License No �" �-'` Date 'L'�tr�U , 19 <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 188 (REV.9.69) 5s39t•95o)o-6s cow TRIP 0 A osp <br />