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VeA <br /> l <br /> ORIGINAL STAVE OF CALI FORN[A 'tib ` DO not fill <br /> THE RESOURCES AGENCYR <br /> File with DWR DEPARTMENT OF WATER RESOURCES No. 154083 <br /> (.tent N,,. WATER WELL DRILLERS REPORT state Well No. I <br /> L.ca. Perout No, or Date Other WeII tiro. �o�EI (� <br /> (1) OWNER: N:yn,e Al SbLutt 12) WELL LOG: 135 <br /> Total depth _ft. Depth of completed weL 103 <br /> Address 1901 Mello C t from ft. to ft. Formation (Describe by color, character. size or material) <br /> Ci,. Tracy zip 0 1 ToD XWJ3 Soil <br /> (2) LQanTIOa QF WELL (See instructions): <br /> uin 1 _ Cla <br /> Conty Qu1�1 Sad ix Owner's Well Number <br /> Well addre-ss if different from above 4699 Durum Ferry Road <br /> T­-nship Tracy Ram: Sectio 101 - 20t Sand & Grava t <br /> Distance from cities, roads, rtilmads, fences, etc. <br /> 211 t - 411 Sand & Clay <br /> ' 51, Sand & Gravel <br /> �X (3) TYPE OF WORK: <br /> New Well Z Deepening ❑ 511 r, 1�.�60' - Sand & Clay <br /> y <br /> Recnnstnyction 0 <br /> Reconditioning ❑ 1 <br /> / _ t ' t I la <br /> Cla <br /> Horizontal Well ❑ _ <br /> t Destruction C1 (Describe <br /> destruction materials and <br /> 78t - - C�5 t Sand of Gravel <br /> e r�'t+ proceures in Item 127} _ <br /> r d '\ T <br /> �01 (-;) PROPOSED USE t (1o r' � <br /> �• Domestic <br /> Irrigation ❑ 1 N1 t - O I Santo <br /> 1 r`L Industrial ❑ <br /> Test Well © . 1101: J 120, Clay <br /> Stock <br /> Municipal ❑ 1201 - 127r Sand <br /> WELL LOCATION SKETCH ,• Other ❑ <br /> i) EQUIPMENT: (6) GRAVEL PACK: - _ - <br /> Rotary M - Reverse ❑ YmXj No C] Size 3j8 <br /> `:ahle ❑ Air ❑ Diameter of bore 7 = <br /> Other ❑ Bucket ❑ ' Pack4fmm 701 tm 103 <br /> I i F CASING INSTALLED: .- (8) PERFORATIONS: <br /> Steel j] PIastic ❑ Type of perforatinn or Aie of screea ^ - <br /> Froin To : .Dia. Gaga. r/ From-\ To - <br /> ft. ft., •in. WaII ft fL /"< <stZ4 <br /> 83 1 ",\3/16x4 - <br /> (9) WELL SEAL; V _ <br /> %Vas surface sanitary seal provided? Yes 0 No ❑ If yes, to depth 50 ft. _ <br /> Were strata sealed against pollution? Yes Q No ❑ IntervaL _n- --ft• _ <br /> Methmxi of sealin- Bentonite Work started-_ 19 `� Completed lg `+. <br /> 10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if known_ 101 TO 201 - <br /> -ft- <br /> 01ft. <br /> ThIT well was drilled under my jurisdiction and this report is true to the best u/ my <br /> Standing level after well completion ft• knowledge apid belief. <br /> ' I1) WELL TESTS: S[CxED .� <br /> Nays well test made? Yes 0 Na M If yes, by whom? -r- (Well Driller) <br /> rype of test Pump ❑ Bailer ❑ air lift ❑ N tri � j <br /> )epth to water at start of test -0� ft <br /> 1�- Supply Tnc <br /> At rod of test_ �0� h _ iPersua, firm, nr corporation) (Ty or printed) <br /> Ped p ) <br /> "e �Q_ Ralimin fler -0- hours Water ten emture1 - Address 3 Reed Road <br /> ud analysis made? Yes ❑ No ❑ IL yes, by whom? r City 0;;krlal P Zip - <br /> Vacs electric lost made? Yes ❑ No (] If yes, attach copy to this report-0t License to. 360-851 Date of this repro 1.1 88-84 <br /> 1WR Ia8 1tray. 7.741 IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />