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STATE OF CALIFORNIA <br /> ORIGINAL N%we THE RESOURCES AGENCY v+ Do not fill in <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT No. 325332 <br /> .notice of Intent No. State Well No. <br /> Local Permit No. or Date E5 A—2 6 Q 8 � � -- Other Well No. <br /> (1) OWNER: Name (12) WELL LOG: Total depth 240 ft. Completed depth 240 ft. <br /> Address from ft. to ft. Formation(Describe by color,character,size or material) <br /> ciiv Tracy . Ca _ ziP 95375 0 _3 Tcp Soil <br /> (2) LOCATION OF WELL (See instructions): 3 — 1 6 C 1 d <br /> County Owner's Well Number 16 —25 5dfld <br /> «'elk address if differe t Ern above 1 <br /> 25 —78 Clay <br /> Township Range 9 C Section r 78 —81 Grave l <br /> Distance from cities, roads, railroads, fences.eta 81 —85 C 1 a <br /> 85 —95 Gravel <br /> 95 — 110 Cla <br /> 110 — 120 Grave <br /> (a) TYPE of WORK: 120 — 125 C,4 a <br /> 125 — 1 3 5 63,rdy e 1 V <br /> New Well)tX Deepening ❑ 135 —2,31U C 1 <br /> Reconstruction ❑ <br /> R 112 3 Q Gra e l <br /> Reconditioning /> <br /> Horizontal Well ❑ `\ <br /> i Destruction ❑ (Describe J� <br /> destruction materials and pro- <br /> cedures in Item 12) <br /> (4) PROPOSED US <br /> Domestic <br /> Irrigation f1 i <br /> Industrial \ \ ❑ <br /> Test Well `� ❑ ^ <br /> htunicipwl\ ❑ <br /> i \ <br /> Other \� ❑ — . <br /> WELL LOCATION SKETCH < (( �c�be) — <br /> (5) EQUIPMENT: GRAVED ACK: S,aii (` � <br /> Rotary)a Reverse ❑ <br /> s \ <br /> Cable El Air ❑ etel�of bore — <br /> Other ❑ Buck e ac7ced from 10 0 to SL_ft <br /> cv ! e <br /> i (7) CASING INSTALLED: (8) PERFOf ATIONS: — <br /> \ <br /> steel El Plastic Ex n Ret1s Ty of( o\kj Xon or size of — <br /> From T i Cage or t — <br /> ft. f i Wall t. size — <br /> 0 240 160 220 Scree — <br /> 1 — <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yes}a No ❑ If yes,to depth �-0 ft. — <br /> t Were strata sealed against pollution? Yes ❑ No ❑ Interval ft — <br /> Method of sealing RENTONTIE Work started 19 Complete 19, <br /> (10) WATER LEVELS: WELL DRILLERS STATEMENT: <br /> Depth of first water,if known ft. <br /> This well was drilled under my jurisdiction and this report is true to the <br /> Standing level after well completion 27 ft- best of my knowledge anl belief. <br /> (11) WELL TESTS: Signed ��:�Was well test made? Yes ❑ No Q0 If yes,by whom? (Well Drilter <br /> ''ype of lest Pump ❑ Bailer ❑ Air lift ❑ NAME <br /> Depth to water at start of test ft. At end of test ft. (Person•firm nr(xrrporation)(Typed or print�ti) <br /> Discharge gal/min after lxwrs Water temperature Addrms_3525 P 1=1 ANDA 1 F A V F _ <br /> (:heroical aratysis made? Yes ❑ No M If yes,by whwn? City r ZIP 951;6 <br /> — <br /> Was electric log made Yes ❑ No In If Yrs,attach o,pv to this rrixrrt License No. _2_9 fl R 1 3 -_ Date of this report _DZr IQ IQ <br /> OWR 188 (REV. 12-Bel IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM ap 76-155 <br /> 3 <br />