Laserfiche WebLink
RIGINAL STATE OF CALIFORNIA Do not fill:n <br /> THE RESOURCES AGENCY NO, 065056 <br />(e with DWR DEPARTMENT OF WATER RESOURCES <br /> tent No -7 WATER WELL DRILLERS REPORT Stite Well No <br /> Permit No or Date U/ -6 71 Other N1` <br /> ell 002-505"E <br /> OWNER 'Same Tracy Equipment Rental (12) WELL LOG Tot it deptn2QQ__ft Depth of completed +tell _L:l._-ft <br /> dress n t t fmm ft to ft Formation (Describe by ccilnr character size or matenal) <br /> T zip 95376 0 - 5 TOD 5011 <br /> LOCATION OF WELL (See Instructions) 20 _ <br /> 24 Sand <br />,unnS a n d o t�n u 1 n Owner s N%ell -Number 24 - 35 Clay <br /> t11 address if different from abrne <br /> ' <br />,++nship Rani.e secti35 - Al Sand <br /> sectio 35 <br /> - 4 7 C 1 a ` <br /> istance frc.m cities mads railmadts fences etc W t Of <br /> hrlsman Rd . a 7 71 Gravel.- A Sand <br /> - <br /> 7S - <br /> (3) TYPE OF WORK <br /> hes+ 11 ell k Deepening ❑ <br /> k <br /> Reconstruction ❑ - <br /> Rec[indltioning Li <br /> Horizontal Well ❑ - <br /> Destruction ❑ (Describe - <br /> destruction materials and <br /> procedures in Item 12) - <br /> (4) PROPOSED USE <br /> Domestic ] - <br /> Irrigation ❑ - <br /> Industrial ❑ - <br /> �� Test Well ❑ <br /> Stock ❑ <br /> Municipal ❑ <br /> WELL LOCATION SKETCH Other ❑ <br /> 5) EQUIPMENT (6) GRAVEL PACK Sand <br /> tot,Ii} Retersc ❑ lee -No ClS[ri��ze f - <br /> ihle ❑ Air ❑ Diameter of bore 2 Il - <br />)tber ❑ Bucket 0 Packed from - <br />-i CASING INSTALLED (S) PERFORATIONS - <br />+tcel © Plastic Cx Concrete ❑ Ttpe of perforation or sire of screen <br /> From JbG <br /> Dia Gage or From To Slot J <br /> ft m Wall ft ft s.ze - <br /> 0 16 Lu, b5 75 `.creen - <br />(S) WELL SEAL <br /> 1t is sort u[ ,iii tan seal pros[ded' S es EN N, a if t es to depths-- —ft - <br /> V1cre strata sealed against pollution? S es ❑ Nu {] Int(.n tl ft <br />%fc thod of sealiniz Q e n t o n 1 t e 1\ork st lrted_ ._l5 Coniplet —19- <br /> 10) WATER LEVELS N ELL DRILLER S STATEMENT <br /> Depth of first ++ater if knox ft This well tuns drilled under mi, turisdichori and ih[s r[po�a true to th[ hitt u/ trill <br /> ft lltio[t ledite and beliefr <br /> Stindmg level after ++ell completlo <br /> 111) WELT. TESTSSIC\ED �-- <br /> (Well Driller) <br /> 11 is Hell tett iotdel ars ;7] \o [X If fes bt t+hom' <br /> TN Ix of test Pump ❑ Bader ❑ Air lift ❑ NAME H E N N I N G <br /> (Person firm nr corporatmn) (TN <br /> ped or printed) <br /> 1Je Atli tit %%der it st in of fes[ ft A! end of test 4t 3525 P E L A N D A I-F A V E- <br /> i� ��„^�,al/min sifter hours \1,Iter tempt.ntture 4ddress <br /> cit. MODEST zip—_9 <br /> al and+sis niade� Y[s C No [x If >es bi N%lion)? - <br /> t1 is [lectne log made' Yes ❑ Aro If fes attach eopv to this report License No 29,0813 Date of this repo <br /> DDR Ise (REV 7761 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />