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ORIGINAL' STATE OF CALIFORNIA Do not fill in <br /> THE RESOURCES AGENCY <br /> File with DWR DEPARTMENT OF WATER' RESOURCES Na. 219001 <br /> ,e„f Intent No._— WATER WATER WELL DRILLERS REPORT State Well No. <br /> i Permit No. or Date 04-329 Other Well No.02SaSZF2.7 E <br /> ( 1) OWNER: Name Tracy Ice Development UO. (12) WELL LOG: Total depth 1 60 ft. Depth of completed well150 ft. <br /> .,ictrrss 2 OO S o McArthur <br /> from ft. to ft. Formation (Describe by color, character, size or material) <br /> t Tracy, Ca zip 0 - 3 TO Pfoil <br /> ( 2) LOC ALTION OF WELL (See instructions): 3 - 2 8 Clair <br /> 2 _ 2 9 Grave 1 <br /> C: ,nty San Joaquin Owner's Well Number <br /> 'Xell address if different from above 29 <br /> — Clay <br /> an <br /> ' wnship Raru., Sectio v �+ <br /> Distance from cities, roads, railroads, fences,etc South of Old H — Cl <br /> 50 1 6 - 78 Gra V&T- <br /> east side 7 - 125 .Cla <br /> 125 - 145 ',Ctravel <br /> (3) TYPEOFWORK: 145 160 Clay <br /> New Well LX Deepening ❑ <br /> ( Reconstruction Q — ��,�• ��,�• <br /> Reconditioning ❑ — <br /> Horizontal Well ❑ — <br /> Destruction ❑ (Describe — <br /> destruction materials and- <br /> procedures in Item 12)t — <br /> (4) PROPOSED USE <br /> Domestic <br /> Irrigation - ❑ — <br /> Industrial ❑ <br /> Test Well ❑ — <br /> Stock Q — <br /> Municipal ❑ — <br /> WELL LOCATION SKETCH Other ❑ — <br /> i I EQUIPNIENT: (6) GRAVEL PACK: Sa—n-d & — <br /> Rotary i Reverse ❑ Yesk No ❑ Size Gravel - <br /> rc _ <br /> Cable t= Air ❑ Diameter of bore 1 <br /> ((�� <br /> Other Q Bucket ❑ Packed from�CCto 1�• <br /> (7- CASING INSTALLED: (8) PERFORATIONS: — <br /> Steel ❑ Plastick, Concrete u, Type of perforation or size of screen — <br /> From To Dia. Gag eor Froin U To ,.Slot- <br /> ft. ft in. Wall ft. ft. `size. ' - <br /> 0 150 •: 1 0 120 15 Creen I - <br /> (9) WELL SEAL: <br /> '.Vas surface sanitary seal provided? Yes No Cl If yes, to depth___5_CL_ft. <br /> Were strata sealed a8ainst pollution? Yes C3 No ❑ Interval ft- <br /> Method of sealing bentonite Work start Completed 19 <br /> 1W WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if know R. This well teas drilled uruler my jurisdiction and this report is true to a beet of <br /> Standing level after well completion--- g. knowledge and belief. 1 <br /> n <br /> ill) WELL TESTS: Slcxsn <br /> Was well test made? Yes ❑ No aj If yes, by whom? t�����T n� �}(well Driller 7T { �r <br /> Type of :est Pump Bailer I_'' Air lift ❑ VANfE HE IN I GS IJ�ROS� .DRILLII d, � O• ) IN C.- <br /> Depth to water at start of test ft. At end of test ft (Person, firm, or corporation) (Typed or printed) <br /> PELANDALE AV i_-Q-7. <br /> Discharge gal%min ,ifter hours Water temperature <br /> Address- 3525 <br /> L <br /> Ci MODES TO, ��4.- ,. zip— <br /> Yes <br /> 3 5-CJ — <br /> r.ical analysis made? Yes No `g If yes, by whom? ��(��¢¢� 1 lJ <br /> electric L,t; made? Yes :❑ Vo If yes, attach ctroy'W this report - License No__2_9 t+ �—' "rate o4 thn repo <br /> DWR 188 (REV. 7.76) IF ADDITIONAL SPACE IS NEEDED. USE {NEXT CONSECUTIVELY NUMBERED FORM <br />