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<br /> STATE OF CALIFORNIA Do Not Fill In
<br /> THE RESOURCES AGENCY
<br /> ORIGINAL DEPARTMENT OF WATER RESOURCES N° 91241
<br /> File with DWR
<br /> WATER WELL DRILLERS REPORT State Well ND.
<br /> Odic, Well No. 's
<br /> (1) OWNER: (1 1) WELL LOG:
<br /> Name Douglas Oil Co. Station Tot,l depth 7 ft. UcpJ,of cu,nple,.d will it.
<br /> Address S.W. c-)r. Lower 1,43Cto rd. and Hiway 12 Formation: Druritr Gy rotor,rha.erlrq of nrafrrial,u+d sfrurturr
<br /> Lodi 0 f,.,,, f ft.
<br /> (2) LOCATION OF WELL: Z1 z4 Sand
<br /> I
<br /> l.w+mv S. Jo Owner's number.if any 74 4 z Clay
<br /> Township,Mange,and section 4� 48 Sand
<br /> D,,,anae from .ad,.r,il,-d,.e,a. 48 69 C 1 e
<br /> 69 82 Sand
<br /> (3) TYPE OF WORK (check): 82 102 Clay
<br /> New Well Deepening ❑ Reconditioning ❑ Destroying ❑ 102 —10 C Sand
<br /> If destruction,describe nrate•rial and hrocedurr in Item 11. 106 1z8 Clay
<br /> (4) PROPOSED USE (check): (S) EQUIPMENT: 1z5 144 Sand
<br /> Domestic fl Industrial ❑ Municipal ❑ Rotary F[} 144 C 1 ay
<br /> Irrigation ❑ Test Well ❑ Other ❑ Cable ❑
<br /> Other ❑
<br /> (6) CASING INSTALLED:
<br /> STEEL: OTHER: If gravel packed
<br /> SINGLE, DOUBLE ❑
<br /> Gage Diameter
<br /> From I u or of From l o
<br /> ft. it. Diam. Wall Bore ft. ft.
<br /> 0 124 6 .10
<br /> seze of shoe..r wrll rink: = by 2 si+.e of e—cl:
<br /> De—ibr lo,nt ',-,'e 1 d e d
<br /> (7) PERFORATIONS OR SCREEN: None
<br /> l ype of pert—toon or name of screen
<br /> Perf. Rows
<br /> From To per per Size
<br /> ft. ft. row ft. in.x in.
<br /> (8) CONSTRUCTION:
<br /> WV a,urlacc san,ra ry seal provided? Yes qr] No 1-1 To what depth C-2 ft.
<br /> w au scaled against poflo,lon? Yc, ❑ N,, ❑ if ,note depth of arau
<br /> Prom it. to f,.
<br /> Prom - ._ .._ fr.t ft. uork, eJJul 27 ty7? .croroe,ed July �O ly 7z
<br /> ale,h„d.,l .rali,4
<br /> Ce-nen". zrout V*1:1.1- DRILLFR'S STATEMENT:
<br /> 9 WATER LEVELS: This u•r/1 aras drillyd ander ill I- jurisdiction and Ibis rrhort is trut- to for first
<br /> ( ) of m knotcled e and hcf .ef.
<br /> Uepth at which water was first found, ,f known �,l� f,. .
<br /> sanding love1 before rerforating, if known 1t. \n�11•; J. 1. �'aalha?ne2' Co.
<br /> (1'rrson,firm,or corporation) (Typed or frwre, 1
<br /> ndi,`: level after prrf—a,o,g and de•veloping ft.
<br /> (10) WELL TESTS: Address 752` Aildree
<br /> was pump test u,adc? Yea 411 No j] If ccs,Iw wi m? '•lc1 dr 111 eti' .3toct;ton
<br /> 145 1 hn (SIGNED) �,Z L
<br /> 1'n•LL• cal.-nun.with (t.drawdown al tam
<br /> r<nipe"t a•of water Was a chemical anaFrsi,nude? Yes(_] No ❑
<br /> WJul ZJ as elrctne h.g n,aJr of well? Ye, 1 I No i lis at copy I i.t'n,e i\u- � I):7[Cd197-;'-,- �.._� 1___-. 19
<br /> SKETCH LOCATION OF WELL ON REVERSE SIDE
<br /> DWR ItiB ,wry —;,t, es,':. n..1.6e s.M T RIP AD osR
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