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CRIGIVAL Ile Original,Duplicate and Triplicate wfth the WATER WELL DRILLERS REPORT Do Not Fill in REGIONAL CATER POLLUTION�A�?0tLV01K(s`ctronr 7076,7077.7o» macs cad.) N? 24315 CONTROL HOARD No QN� O` gpp►RD # STATE OF CALIFORNIA - Stam*eu No _ _____ {tnrni aypropreatr amubn) Other 1 ------ y er Wt .No ! ) OWNER: (I I) WELL LOG. Name K:LnR & Stevens Tptzl depth 882 ry I �+� ir++ it Depth of completed well 825 f[ Address 114 l j a Emerson, Tracy, Calif o Formatroa Desnrbr by rater,ebararter,use of evoirrsal,sad siraciare ft to it Tot? Soil Brown Sand (2) LOCATION OF WELL. Yellow Samdy Clay cauntySan ,roaamn Owner a amber if any— 34 #7d2 V-- Sand A F D or Street Na 1000 Fiji E Of the intersection of23 Coarse Sand _KRL4MX 33 & Durham Fera Rd — SW 1 GravelGraveli, some Cla Section 16 T 3S, R 6E HD Gravel C & Gravel 123 2jz- Yellow Clay & Gravel (3) TYPE OF WORK (check). -1471 155 Free Gravel 155 18g New well >Z Deepening ❑ Rccoad,uonttt Y ow Clay & Gravel 8 ❑ Abandon ❑ 173 G 8vel It abandonment,describe material and procedure in firm i i _ 23 S Cla (4) PROPOSED USE (check). (5) EQUIPMENT: —let) Freer—avel Domestic ❑ Industrial ❑ Municipal ❑ Rotary ® 190 YPI low Sti Cla Irngation ® Test Well ❑ Other ❑ Cable [] 200 245 Gray Clav Dug Well 0— 2Z5 290; 'Al Ile Clav (6) CASING INSTALLED If gravel packed ClAV & Gravel SINGLE l3 D0lf9LE D GaIY7 fn a Clqy � Demeter from to From ! 322 33!q Gr oft ,.335 3 _� •ft 161/ram if 4 WaI] of Bon ft •• ft 825 12 1 a0" n25 S bale P54 _q!7n Sand . Rom • & GrLy Gla Type and arm of shoe or we"rsna note Ss:e of RisenGra T Deaersho jurat 1 and eyn, d (7) PERFORATIONS. 462 420 Vel'1 tom.; S—�ndv Clav (Hard) _ Type ofparfotatore.ed Factor4 milled '" ders Tz^ht - - Yellow Cl & Gravel Size 1 8fr to 16 eaRth b of Derferaneas In,l 499 F�__ 160_ ft Perf per rew I Roo.,per it _-- Gravel & Boulders Tight 177 2004 r S!i- _ 5QL 612 Yellow Sandy Clay s 6 Yellow Clay & Gravel 05 28 y t 6201, �' �' ti ` 405 9 a c,52i 619 6415 Yellow Cla 446 48 c) Ib6741 1 s _ A455 682 Yellow Clay & Gravel If 7441 69 810 s 2. 87 Gravel s, some Boulders (8) CONSTRUCTI N. x Ye31ow C1a some Boulders - Was a awface aan[tarr seal prorrded7 ❑ Yea [I No To vlut depth '"le _ Yellow Sand Cl Ware.ny strato sealed azaraac pollutsoo r ❑ Yn .. Yellow rile i� No If yes non depti+of strata 746 751751 365 FromSand Cla some Bouldersfc to fc 791 Glavd & Gravel (Hard Strews; Co Method of Sealing Wort started 19 Compined 19 i (9) WATER LEVELS- WELL DRILLER'S STATEMENT Depth At which nater was fent fenad not avaz.lable it Tb'= well was drilled strider ray jurisdiction and this report is trate to the belt of my knowledge and belief Staadiaj keret before perfor'.1t IT 1a it anR after per(oraNAME UESTERI"I i IJ�•rj, DRILI ING CO. LTD _•_ aeon lcrel 41 11 f[ (Person nrm Dr corptrauon)• r7yprd or Dr+wrrJ)� Address P. 0. Box 47 .(I o) WELL TESTS I 7 Wu s pump trot modes Ye: ❑ No If les 6j ejioais driller _ __ -ice �C-t`�rCi Rak/min verb ft drag dura afur bra [SIGHED] � �a��r Wr1!Drrflrr V 58 We, of nater War a them-eal:nal ysrs made? [� Yes No _ L5�82 Dated-- _ � ..t � I9 ^'• Lrccn�e No _ We,electric lean made of velli Yea ❑ No 9aa80 a as soM ouiN Q aro � DWFt 1'oRrq NO 246 1REV 9 5ai