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QRIGINAL' _ ��� STATE OF CALIFORNIA . � Do not fill in <br /> — THE RESOURCES AGENCY NQ, 065061 <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> ,.f Intent No. WATER WELL DRILLERS REPORT State Well No. _ <br /> ..a Permit No. or Dice R 7 R 10 Other Well No6Z SIO G� <br /> 1 OWNER: Name Century 21 Yeomans Realty 12) WELL LOG: Total depthLLQ-ft. Depth.,f anupleted weil.---Lam <br /> utairrss P . O . x 1212 from ft. to ft. Formation (Descnbe b. a)lur, character. size •Ir material) <br /> Trice , Cazip :5370 0 - 7 Top Soil <br /> LOCATION OF WELL7 - 9 Sand <br /> �7 (See instructions): l <br /> c... San ,l o a g 4 i n Owner's Well Number 9 q - 64 C l a S a' d <br /> «-ra address if different from above 8197 V1 . Hwy 50 Tracy 64 - 66 Sand <br /> L•<vnship 0 2 5 Ranee Sectio 66 - 105 Clay `Distance from cities, roads, railroads, fences, etc.— 105 - 119 G r a,'e 1 <br /> - 170 C I a <br /> ' (3) TYPE OF WORK: =i <br /> New Well :3( Deepening ❑ <br /> i Reconstruction ❑ _ <br /> - Reconditioning <br /> Horizontal Well ❑ _ <br /> Destruction ❑ (Describe - <br /> destruction materials and <br /> procedures in Item I2.)• _ <br /> (-I) PROPOSED USE: i - <br /> Domestic _ ( _ <br /> Irrigation _ <br /> L; f <br /> Industrial ❑ _ <br /> i <br /> Test Well _ <br /> 'Stuck <br /> ]tunic:pal - <br /> WELL LOCATION SKETCH Other _ - <br /> EQUIPMENT: B) GRAVEL PACK: ,C,a n d o - <br /> R..tar: Reverse i Yes 7l1 No ❑ Size Gravel _ <br /> 12" <br /> Air ❑ j Diameter.,t bore - <br /> 1)rhrr "� Bracket — i Packed-from__L0_'(' 1 2 5 <br /> CASING INSTALLED: I 8) PERFORATIONS: - <br /> ;teei Plastic IN Concrete i Type 4 perKnation or-ize of screen - - <br /> �r:;in To .-1.Dia. j Gazer Brom; . - To Sint. - <br /> it. j ft. �/in. I Wall + ft.-,;; ft. <br /> U 12� <br /> C7\'%i 16 0 10 5 v 125•-x. •'Screens - <br /> 9) WELL SEAL; 77 n� _ <br /> a> oar uce sanitary �eui provided.? Yes t j Nu _ if es, ;n depth 7n <br /> l'»- strata sea!ed against pollution? Yes J No interval t. _ <br /> 1te-hod ,>f sealiner� <br /> B n t2 n i r P ' '.V"rs ;tortedNI a r �2 <br /> - Is_2—Z l.wnplr[hi <br /> WATER LEVELS: 7,A LL DRILLER'S STATEMENT <br /> De•;th f 'first water, if `.mowrt - -`t- rhes u:eil :cas drilled under ntq ninvdic•tion and rhi.c rrnn.r •.ore -r, he hoer •)r <br /> it. a;,n>; revel after well eutnpletitin } t. knotcledge n boliet ' <br /> WELL TESTS: SIGNED <br /> LL'.; -veli :est made? Yes "- No if; If -s, by .vbom? (Neil Driller) <br /> T'-'a <f rest Pump Bailer -7 Air listi `-•1ME H E N N i W G S B R O S . D R I L L I i.1 G Co . I m C <br /> Denm :o .nater at start of test ft. At end •4 test ft (Person, firm, or corporation) •Tvprd nr printed) <br /> p r 3525 PEI ANCA ' ATE . <br /> ' ':r_e kali min after huun '.Fater tem rzaturejddress i <br /> al analysis; made? Yes _ No jt If les, by whom? j City 1 Q D E C T rJ CA <br /> zip_Qlz2E6-- <br /> •� s •ectnc lot made? Yes No If :es. attach coriv ;o ;his -ennrt j cense No Date of this report 141._ r � ' <br /> C;WR 188 iAEV. 7.76� IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />