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IRIGINAL STATE OF CALIFORNIA Do not fill in <br /> THE RESOURCES AGENCY <br /> le with DWR DEPARTMENT OF WATER RESOURCES No. 197578 <br /> intent No WATER WELL DRILLERS REPORT State w ell No� _ut No or Date 86-54c c Other X%ell IroG ... i;-- �" <br /> 1) OWNER N.,f,Jeff Dvxason (12) WELL LOG Tot depth 2r,2- ft Depth of completed µells eft <br /> idress,-.._ 441 LexznF¢'on from ft to ft Formation (Descnbe b% color character size or material) <br /> ii, <br /> Stockton Calif. Z,p e 20' - <br />?) &OCATION QF WELL (See mstntetloils) - _ .. <br />,un an Joaquin -Ox ners well Number p <br /> ill address if different from above 25079 hr 6 S2 Sana <br />„anship_ r'2 CY Range Sectio F� - 1C8 C'l <br /> istance from cities mads, railroads fences, et, -C , Sand arc VG'1 <br /> _ <br /> 2 Clay <br /> (3) TYPE OF WORK <br /> Neµ %4'ell LN Deepening ❑ <br /> Reconstruction ❑ - <br /> ]Reconditioning ❑ <br /> Hnnzontal N ell (] <br /> Destruction ❑ (Desenbe - <br /> destruction matenals and <br /> procedures in Item 12) <br /> (4) PROPOSED USE <br /> Domestic - <br /> IrnRatinn ❑ - <br /> Industrial ❑ <br /> Test Well ❑ = <br /> Stixk Q <br /> Municipal ❑ <br /> WELL LOCATION SKETCH Other ❑ <br /> 5) EQUIPMENT (6) GRAVEL PACK <br /> r in.- <br /> Rever%e {] Yes M leo Cl Si <br /> able L1 Air [] Diameter of bore <br /> tt - <br />)then ❑ Bucket ❑ Packed from 85--t--1Z5---ft - <br /> e) CASING INSTALLED (8) PERFORATIONS - <br /> 3tee) ❑ Plastic Concrete ❑ Type of perforation or stze of screen <br /> From To Dia Gage or From To Slot _ <br /> ft ft In Wali ft ft sac <br /> FVU <br />(9) WELL SEAL <br /> Was surface sanitary seal pm%ided0 l es)Cj No ❑ If yes, to depth----E--5--ft <br /> 1\ere strata sealed ar�nsI gallution7 Yes ❑ No ❑ Interval ft - <br /> 00 <br /> Method n[ seabn <br /> tienTOnit.e Work started 19 Complet =-4 C8 19 <br />(10) WATER LEVELS WELL DRILLER'S STATEMENT <br /> Depth of first water if knaµn ft Thtx well was dnlled tinder my jurisdiction and th reparj is tnie to the best of niy <br /> Standing level after well coniplettn.. knowledge and behej <br /> ft <br />(11) WELL TESTS SIGNED <br /> (Wed Driller) <br /> N as well test madeo les 0 No ❑ If %es by whmn7 <br /> I's pe of test Pump t] Bader ❑ Air lift 0 NAME <br /> no <br /> Dc pth to water qt start of test ft At end of test ft (Person firm or corpora Lou) ( ped or p?Inti <br /> 11 a cal/mut after hour Water temperature Address a C)n S .- K-1 I rc))E <br /> Tur] Qck <br /> analysis made les [] No ❑ If yes by whom? Cit —Zi <br /> �t its a e" c Int madeP los ❑ No ❑ IF jos attach cupti to ibis report License No <br /> --—Date of this report 6— <br /> i <br /> � Cl <br /> awR 188 (REV 7 761 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />