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)RIGINAL STATE OF CALIFORNIA Do not fill in <br /> THE RESOURCES AGENCY <br /> le with DWR DEPARTMENT OF WATER RESOURCES No. 16QQ CC�� <br /> 8 9 0 <br /> *tent No WATER WELL DRILLERS REPORT St it, \l ell No <br /> <� <br /> it No or DateVC.rT-'3rI 24 Other \'l elld5f�- <br /> 1 ) OWNER name Brian bt e1 x Fe r (12) WELL LOG Total depth2 1 Lft Depth of completed w eli Q()ft <br />-{dress L5Oh9 Chrisman :Tedd froin Et to ft Formation IDescnbe bN color character size or matcnzl) <br />,ti Tracy, Calif. Zip 0 - 33 Ton soil clay <br />'_) L CATIQN OF WELL (See instructions) � - 6 Gravel <br /> Dar_ oaovzrz 6 - �srown clay <br /> uunh Owners \Sell Number <br /> ell address if different from above 27111 Cnrlsman Rd, �S — �1 Gravel <br /> l 1 - bro vrn c a� <br /> .Nnship 'lr2`C'i�Ran;�e c� Section 1E F <br />}rStance from titres roads railroads fences etc �`� — r Gravel <br /> - <br /> 217 Brown clay <br /> (3) TYPE OF WORK <br /> New Well KI Deepening ❑ <br /> Reconstruction ❑ — <br /> Reconditioning ❑ — <br /> Horizontal Well ❑ — <br /> Destruebon ❑ (Describe — <br /> destruction materials and <br /> procedures in Item 12) — <br /> (4) PROPOSED USE - <br /> Domestic T..,r 1 V M — <br /> Irril,atinn ❑ <br /> Industrial D — <br /> • Test Well ❑ = <br /> Stock ❑ <br /> Municipal ❑ <br /> WELL LOCATION SKETCH Other ❑ <br /> 5) EQUIPMENT (6) GRAVEL PACK — <br /> Aotan d Rexene ❑ les 0;_ No ❑ Srze F Y+ — <br /> ir <br /> able Cl Air ❑ Diameter of bore — <br /> Aher ❑ Bucket 0 Packed frorn �.� M ei <br /> 7) CASING INSTALLED (8) PERFORATIONS — <br />,teel ❑ Plastic M Concrete p Type of perforation or size of screen — <br /> From To Dia Gage or From To Slot <br /> ft ft in I Wall ft ft size <br /> 0 UO 6 1 16o 20 90 <br /> EIS I - <br />(9) WELL SEAL - <br /> 1\as surface sanitary seal provided les No ❑ If yes, to depth5 5 ft — <br />\\ere strata sealed against pollution? Yes ❑ No ❑ Interval ft — <br /> Nfethod of realm+ Work start. 19 Complet 19 <br />(10) WATER LEVELS WELL DRILLER'S STATEMENT <br /> Depth of first Nater if knoK_ ft This well was drilled under my jurrsdiction and this report is tree to the best of my <br /> Standing level after Nell completio.. g knowledge and belief 1 <br />(11) WELL TESTS SIGNED^ Uf4-A-4, Bkkpr.. <br /> (Well Driller) <br />%%as well test made2 les ❑ No ❑ If 3es by whom? Co . , <br /> T,pe of test Pump Cl Bailey ❑ Air lift ❑ NAME Calwater, Drill in Inc . <br /> I)epth to water at start of test ft At end of test_ ftPerso�nt firm, or corporation) (Typed or printed) <br /> D e_ <br /> nal/min after hours Water temperature Address 36d "� �1�a-lro <br /> analysis mad0l les [] No ❑ If yes, by whom City Turlock Califs dip p <br /> electn( log, made9 les ❑ No ❑ If res attach copy to this report License No, 321252 mate of this rep* <br /> DWR 166 (REV 7 76) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />