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_ Do Not FrIl In <br /> STATE OF CALIFORNIA <br /> THE RESOURCES AGENCY NO 89320 <br /> ORIGINALDEPARTMENT OF WATER RESOURCES <br /> File with DWe State Wdl No <br /> WATER WELL DRILLERS REPORT - ; <br /> Other Well N7 s <br /> (1) OWNER (1 I) WELL LOG <br /> Name lqer Total depth 111 ft Depth of completed well 6 fr <br /> Address It,r Formation bnrrehr F} iul^r rJararlrr sir of nre7c roof and airvrlrrrr <br /> Tracy, Calif. f[ to ft <br /> (2) LOCATION OF WELLLa g <br /> catunty I7 j a a uin 0—er s number If an+ Wy Well ! <br /> Township Range 2nd Section T2S tP 5E qq 7� <br /> i_ <br /> D,stsnce from crves roads ra[Irnad, etc Chrisman OC O — <br /> 20 - Ea nd <br /> (3) TYPE OF WORK (check)• 29-10 Sand <br /> New Well E Deepening ❑ Reconditioning ❑ Destroying ❑ 46 a <br /> if destruction,describe material and procedure to Item 1I <br /> 46-67 Sand Gravel- <br /> (4) PROPOSED USE (check.)• (5) EQUIPMENT —1 <br /> Domestic X] Industrial ❑ Municipal ❑ Rotary ® —1 <br /> 01 Saja� <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable ❑ 1 Clay <br /> Other ❑ <br /> (6) CASING INSTALLED• <br /> If gravel packed <br /> STEEL X OTHER <br /> SINGLE l] DOUBLE ❑ <br /> Gage Diameter <br /> From 10 or of From To <br /> ft ft Diam Wall Bore ft fr <br /> Size of shoe..r will nnl, Sat of crawl <br /> Aeocnbe jawi <br /> (7) PERFORATIONS OR SCREEN: <br /> Type o1 perlurarrun or name of screen 1 <br /> t t� <br /> t —• <br /> Perf Rows p _ e 5a- <br /> From To per per Size <br /> It ft row £r to x to <br /> Z8 x <br /> 52 65 <br /> 1T <br /> (8) CONSTRUCTION- <br /> Wit burlata.amrary seal provided le jd No ❑ To whar depth fr <br /> VL err aus ,u.ta xa1.J acainst pr Ilei inn a Yra I] <br /> No❑ If yes note depth of strata <br /> Brom ft en ft <br /> bruin ft to ft }fork .torted I9 Completed 19 <br /> ttnhud til a,aknl, i` u I'LL DRILLER'S STATEMENT <br /> (9) WATER LEVELS Thr[ uell ods drilled under rub frrrrsdutron and Ibli rrpoet n !rare to tljr brit <br /> of nil knoaledgr and belief <br /> Depth at ah+ch water was first found if known fr <br /> Isssl htfure perforatiok dknown fi NAME He ningsr Drilling O In <br /> e . <br /> {per.on firm or eorp^racion) (Ttprd or pnnlyd) <br /> Standlrsg ksel after prrfnntinF and dcsdopsng It <br /> (10) WELL TESTS Address 2500 W. Rumble <br /> + mP test made? Yes ❑ No IK If yes hI -horn, Mad <br /> e <br /> R-1 /min w+ih f[ drawdown afar hrs [SICNED1 r <br /> rt rature of water fA'r!!Unllr <br /> mpr Was a el+cmtcal analy srs made Yrs ❑ No � ren2 <br /> V✓a teles ins log made of tie Ili }st ❑ No If yes attach copy LICCnSt No 116 2DarCd-- �^ 19—7t—._7'] <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DW R 186 (REV 9 &8i 1411 <br /> 1 2517&o50 9 5B 50M THIP Qn OSP <br />