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ORIGINAL STATE OF CALIFORNIA Do not fill in <br /> THE RESOURCES AGENCY 150881 p p <br /> File with DWR DEPARTMENT OF WATER RESOURCES No. 1 5 0 O 81 <br /> if Intent No. WATER WELL DRILLERS REPORT <br /> $5—1 l $6 Sate Well Na. _ <br /> Ji:alYermit No.or Date Q/S Q(0 1 1 <br /> yyOt��he��r Well No. <br /> (1) OWNER: Name (12) WELL LOG: Total depthleyakR. Depth Of completed wellJO—ft. <br /> Address 109LL Airport Way (So. ) from ft to f. Formation (Describe by calor, character, size or material) <br /> Ci , French Camp, calif- ______Zip-95Q-1-1 - <br /> (2) LOCATION OF WELL (Seeinstmetiow): <br /> Cwnty San Joa.eluin Owner's Well Number l� <br /> Well address if different from above 2 - 2 l ��. <br /> Township'y1' n 1, aRlntangt Sectio 25 - 33 Sand <br /> Distance from cities, mads, ra lruads,fences,etc. - 40 Clay <br /> 40 - 62 Sand <br /> C1ay <br /> (3) TYPE OF WORK: <br /> New WellX Deepening El 12 r <br /> - <br /> Aecrosstruction ❑ - <br /> Reconditioning ❑ - 1 Lo Sand <br /> Hodzontal Well <br /> \ ❑ - <br /> Ut\V ew 4-�t Destructlon ❑ (Describe \ <br /> destroction materia1S <br /> is <br /> P. ad�i V <br /> V-- —. t'L rocedures iv Item Y - ✓ <br /> C <br /> (, t5 P E0.. (4) PROPOSED II ? <br /> Domestic <br /> V <br /> Irrigation(\� VA� ❑ _ r <br /> 'r t Industrial \`,\\\\/ ❑ <br /> Test_Well \- ❑ - - .� <br /> Stocky [] <br /> I'I:d 2( it MunicitrdlJ ❑.. + - <br /> WELL LOCATION SKETCH Other ❑ - a <br /> (5) EQUIPh(ENT: (8)yCAAVF:LACIC: �� - `- <br /> Rotary Reverse ❑ l'es,gy No Ssz <br /> \ ++ <br /> Cable ❑ Air ❑ iAAZtnmeter of bo�re(� <br /> Other ❑ Bucket ❑ rarOm y(� <br /> (7) CASING INSTALLED: (8) PERFO�RA�TION - <br /> Steel ❑ Plastic 11 Commit. Type <br /> Type of. orre of scree `-� - <br /> From To Dia. Gage-er F To - <br /> ft. ft in. Wall Ift. Ft S" <br /> - <br /> 0 140 60 to - <br /> S <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yes (A No ❑ If yes, to depth 51 ft <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval N, - <br /> Method of sealing Work started 19_ Completed--9=2-7-19--&5-- <br /> (10) <br /> omplet 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if known R This well tans drilled under my jurisdiction and this report is true to the best at my <br /> Standing level after well crompletiou g, knowledge and belief. <br /> (11) WELL TESTS: SleNADo.�74fL'i.etJ r <br /> Was well test made? Yes ❑ No E] If yes, by whom? (Well Driller) <br /> Type of test Pump ❑ Bauer ❑ Air hit ❑ NAME CalWater Dri l l i n a Cn_ _ Tnn _ <br /> Depth to water at start of test (t At end of test h (yt on, fi o corporation) yped or printed) <br /> Pis_:=-ge oel/min after Fours Water tempera Address 30b . '3�1 ro; <br /> al analysis made? Yes [DNo ❑ If yes, by whom? CityTurlock, Calif. 72 953$0 <br /> lVas electric log made? Yes ❑ No ❑ If yes, attach copy to this report License No.43421$ Date of this repo <br /> DWR 188 (REv.7.16) IF ADDITIONAL SPACE 15 NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />