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STATE OF CALIFORNIA Do not fill l <br /> ORIGINAL THE RE50URCES AGENCY <br /> File with DWR DEPARTMENT OF WATER RESOURCES NO. 168951 <br /> of Intent N,,. WATER WELL DRILLERS REPORT State Nell No <br /> t ermit Nn. or Date <br /> 88-364 Other Well <br /> ( 1) OWNER: Name Rinaur0 (12) WELL LOG: Total depth ?77 ft. Depth of completed welt 195 <br /> Address 27331 Fair Oaks from ft. to ft. Formation (Describe by a)lor, character, size or material) <br /> City Tracy_, Ca zip 95376 n - <br /> 16 T= soil <br /> (2f) LOCATION OF WELL (See instnlctions): 16 74 _ 'grown cls <br /> Coonty Owner's Wel Numb r 104 Gravel <br /> �cen address if different from above S W corder Or 1 Midi erry 104 — 1 23 Cls & avel Streaks <br /> T,­nship Tracy -03SRante an Bird <br /> Roi <br /> "echo <br /> 123 - 140 Gravel <br /> Distance from cities. roads, railroads, fences,etc 140 - 165 Brown els <br /> 165 - 174 Cravel <br /> 174 - 181 Brown clay & gravel streaks <br /> 181 - 184 Gravel <br /> (3) TYPE OF WORK: 124 - 187 Th-own c v <br /> New Well V Deepening ❑ 187 — _ <br /> Reconstruction ❑ 190 - wn clay & shale streaks <br /> Reconditioning; ❑ <br /> Horizontal Well ❑ — <br /> i <br /> Destruction [] (Describe — <br /> destruction materials and <br /> procedures in Item 12) <br /> (4) PROPOSED USE: - <br /> Domestic 11 — <br /> Irrigation 9/ <br /> Industrial ❑ <br /> Test Well ❑ <br /> Stock ❑ — <br /> Municipal ❑ - <br /> -WELL LOCATION SKETCH Other ❑ — <br /> (5) EQUIPMENT: (B) GRAVEL PACK: <br /> Rotary Reverse ❑ Yes V No ❑ SizeROOf l.n <br /> Cable Air ❑ Diameter of bore <br /> 20" - <br /> Other ❑ Bucket ❑ Packed from 50 to 1 95 - <br /> (7) CASING INSTALLED: (8) PERFORATIONS: — <br /> Steel 6/ Plastic ❑ Concrete ❑ 1 Type of perforation or size of screen <br /> From To _Dia. Cage-or From' _- To < .-Slot . <br /> ft, ft -in. Wall ft ft sizevu Blank <br /> - <br /> 195 12 ' - <br /> er � . <br /> (9) WELL SEAL: Per - <br /> Was surface sanitary seal provided? Yes t$/ No ❑ If yes, to depth 5 ft• — <br /> r <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval ft. <br /> i Method of scaling Work started. 19 completed — 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if know This toed :car drilled under my jurisdiction fend this report is true to the best at <br /> Standing level after well completion Ft. knowledge and bef:ef.' , <br /> (11) WELL TESTS: SIGNED 9 l et � Bkk r. <br /> Nqly weil test made? Yes C No ❑ If yes, by whom? (Well Driller) <br /> Type of test Pump ❑ Bailer ❑ Air lift ❑ NA,)1E C'alwater DrilliLiq Co. Inc. <br /> Depth to water at start of test _ h. At end of test __fit (Person, firm, or corporation) (Typed or printed) <br /> Address 300 S. Kilroy <br /> arge galimin alter _�ttn Water temperature— Tur10Ck Calif. �p 95380 <br /> 'cal analysis made? Yes C3 No ❑ If yes, by whom? City <br /> electric lo¢ mule? Yes ❑ No ❑ IF yes, attach copy to this report License No. 321 252 Date of this report 3-4-88 <br /> DWR 188 (RSV. 7•7e) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br /> 1 <br />