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42UADRUPLICATE <br /> Use to comply with STATE OF CALIFORNIA Do not fill in <br /> local requirements THE RESOURCES AGENCY � ��^� <br /> DEPARTMENT OF WATER RESOURCES NO. 1 c <br /> N t.-F-f Intent No. q WATER WELL DRILLERS REPORT State Well No. <br /> i.oc:d Permit No. or Dare 7 �Vl Other Well No. <br /> 11) OWNER: Name (12) WELL LOG: Tmal depth]--R. Depth of cmnvleted well'• �fr. <br /> Addrme 2 1,1 Al Rd. tram ft. to ft. Formation (Describe by color, character, size or material) <br /> Sto Cktoa, ^.alit. Zip T <br /> 12) LOCATION OF W,�LL (See instmetlons): <br /> I{F` t,mat,_ San Joaq Owners Well Nombe <br /> \\ell add. if different from above 16.26si e <br /> '1'i.aatvhiP RanK Sectio �/� J*�� <br /> Distance fmm cities,roads, milmads, fences,etc. ft Oma' 09 a <br /> y <br /> l (3) TYPE OF WORK: <br /> ` New Well Deepening ❑ <br /> jReconstruction ❑ 30/ <br /> Reconditioning ❑ - <br /> Horizontal Well ❑ f - �' � <br /> f v+ <br /> I Destruction ❑ (Descrihc - <br /> I destroctinn materials and 17- 7-205 ��Oftd <br /> r pmeedurea in Item 12) <br /> (4) PROPOSED USE: 220-a5 G la y <br /> Domestie ❑ <br /> 225 236 5and <br /> Irrigating <br /> k Industrial ❑ <br /> 3Q0w3jG ;and <br /> I Test Well ❑ <br /> 14 Stook ❑ <br /> Municipal ❑ '� fYly <br /> WELL LOCATION SKETCH I Other ❑ _ <br /> (5) EQUIPMENT: (6) GRAVEL PACK: <br /> 1 Rotaq ❑ Reverse 2 Yes Im No ❑ sue-bl-rdjoyc - <br /> Cable ❑ Air ❑ Diameter of hore B - <br /> Other ❑ Racket [ Packed from to�.�_1t. <br /> (7) CASING INSTALLED: (H) PERFORATIONS: louvemd _ <br /> Steel CK Plastic ❑ Comorete ❑ T.Im f per0 nation n o1 sa <br /> p From To Dia. Cage ur From To Slot <br /> l[ ft. ft. iu. Wall ft ft. Size <br /> 1 1x2 - <br /> ! 1.9) WELL SEAL: l - <br /> Was surface sanitary seal provided? Yesfl No M If y to depth-_ft. - <br /> f Were stmta sealed agaimt p"llatinn? Yes ❑ No ❑ Interval ft. I - <br /> Method of sealing \forkstart, P Completed 19 <br /> 110) WATER LEVELS: R'l,LL DRIL,1 H S 'I'A I is f N"P: <br /> Depth of first water, it it I T/o 'd! d.-11d oob, T•m... d Ji um Ir tme in the brat of an, <br /> Straighter level offer avell e•mnhtion _ g_ Ano Mena, nu <br /> 111) WELL TESTS: <br /> %Vas well test .made? to 11 .•.. o whom+� l la,ll U'ai-! <br /> Type id test 11 F" Air hit i] I N,aaap. <br /> Depth to water at start of te, n At end Fit test It <br /> ' Addtesr-_gf,Discharge mal ab tle' r � - 1V t r temp,rah rr l� � - -- -- <br /> Lhemical malyxix mad. le. a .• I i - a1n, y l�P <br /> y' tom}'r -_.—_. - 7535 <br /> Was elettna log mneh"• T,. \\�4g it i h p [ thi report 1 1,:" \ - R Date f this rrpntp�gt7- <br /> DWR lee inev-v.ve� IF ADDITIONAL SPACE IS NE DSUSE NEXT CONSECUTIVELY NUMBERED FORM •=sm-ssa v,7eoToo`o.ra osr <br /> fI . <br /> i <br /> AUG ib 1911 <br /> E SNN JOAQN!N <br />