FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

ORIGINAL STATE OF CALIFORNIA DO not fiU in THE RESOURCES AGENCY NQ, 065056 File with DWR DEPARTMENT OF WATER RESOURCES of Intent No. WATER WELL DRILLERS REPORT state Well No. r ._ Permit No. or Date 87-671 Other Well NoG2—So 2t4r ( !) OWNER: Name__ Tracy E(Vu i D m e n t Rental (12) WELL LOG: Total depth2 0 0 ft. Depth of completed well 7 S ft. _L.dress 7F,34. )' St . from ft. to ft. Formation (Describe by color• character, size or material) <:;n Tracy . Ca zip 95376 0 - 5 Top So i 1 �a i LOCATION OF WELL (See instructions): - 20 Clay C.mnt}•S a n J o ag u i n Owner's Well dumber L:::h - 24 S a n d ;fell address if different from above 24 - 35 C 1 a y �. T�ncnship Rance - Section 35 - 41 Sand Distance from cities, roads, railroads, fences,etc. '/4 Mi . Ilest of 41 - 47 C K risman Rd . a - o 71 - (3) TYPE OF WORK: j New Well K Deepening ❑ Reconstruction ❑ Reconditioning Cl _ Horizontal Well ❑ - Destruction ❑ (Describe - destruction materials and procedures in Item 12)' - - (4) PROPOSED USE: - Domestic }. _ Irrigation Q' _ Industrial ❑ _ Test Well ❑ _ Stock Municipal D - WELL LOCATION SKETCH Other C ❑ - S) EQUIPMENT: (6) GRAVEL PACK: Sand & - H��tan Reverse ❑ 'Yes t.4 No ❑ Size Gr V 1 _ Air ❑ Diameter of bore 12' r)ther ❑ Bucket — Packed.from 3 5 to 7 5 k. _ CASING INSTALLED: (8) PERFORATIONS: - iteel ❑ Plastic f� Concrete ❑, Type of perforation or size of screen,;, _ - From To Dia. Gat; ec F>out� �.) To ft. ft.' ; in. Wall ff, , v ft. �size' 0 75 b1: G. 55 75•_ ci"een - �) WELL SEAL: - si is mrtace sanitary seal provided? YesrA No If yes. to depth .15 ft. - ',Vre ,trata sealed aeainst pollution? Yes V No 1: Interval rt. - 11�rhorf of sealin^ Bentonite Work started 19 Completed 19 10) WATER LEVELS: WELL DRILLER'S STATEJIE\T: Depth of first water, if known - ft. This well was drilled under my jurisdiction and this report is true to the 'nest of in'! Standin¢ level after well completion ft. knowledge and belie}n WELL TESTS: SlcNeO_t� r� 'Xis well test made? Yes No (X If yes, by whom? (Well Driller) i y�W >i rest Pump = .Bailer ❑ Air lift ❑ N ,vfE H E W N I N G S O R O S _ D R T 1 1 T N f rn T W r D-nth to .voter at ,tart •af :est ft. At end of test ft (Person, firm, or corporation) (Typed or printed) "• i'arge ^al,,min after hours Water temperature Address 3525 P E L A N D A 1 F A V�__ cal analvsis made? Yea ❑ No ((A If yes, by whom? City M 0 D E S T 0 . CA Zip 9_rl. � -!cetnc !ot; made? Yes ❑ No :X If yes, attach copy to this report License No. 290813 nate of this repo OWR 188 (REV. 7-76) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM