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LGINAL STATE OF CAUF'ORmA Do not fill to <br /> THE RESOURCES AGENCY <br /> 4; Other <br /> DEPARTMENT OF WATER RESOURCES NO. 129418 <br /> WATER WELL DRILLERS REPORTNo <br /> NS ell No <br /> I OWNER Nntne JiM Jens On {12 210 21D <br /> � WELL LOG Tot,]dip;h h Depth of c<n,iylrted welt (t <br />,ddress 438 Felton Way from, ft to ft Formation (Descnbe by nnlor character awe or rnaten l} <br /> Stockton -Zip- 0 - 4 Xdobe <br /> CAT N OF WELL fSeeinstructions) 21 Brittle cls <br /> 1.t,_..)a_n Joaquin Owners ltiell Number 21 - Soft, brown clay <br />,tell address of different from above 66 - Fine San <br /> nshep Range p Sccho ay ✓� <br /> ance from cities mads railroads fences etc r�r 181 E• - 9 ma 7fa- E <br /> Fairchild, Stockton 96 - 106 C1a <br /> - <br /> �i <br /> (3) TYPE OF WORK A <br /> New Well X Deepening ❑ <br /> 92 <br /> . <br /> Reconstruction ❑ - <br /> Reconditioning 0 \ <br /> ey y Honzuntal N,ell ❑ -16 3-54 Smad and clay layers- <br /> Destructor ❑ (Describe i ?E) Clay and gravel:= <br /> destruction materials and <br /> 4 9C-and and gravel <br /> �i procedures in Item I2) <br /> ~'S (4) PROPOSED USE. 2OG 209 Gra-vel e�nd sand <br /> - <br /> Domestic - `' <br /> Irnganon ❑ - <br /> -industrial 1:1 <br /> Test lNell ' J ❑ , - <br /> Stodk - - <br /> /) Municipal ❑` - - - <br /> WELL LOCATION SKETCH �� Other - Cl <br /> EQUIPMENT (B) GRAVEL PACK \ - <br /> ry ( Reverse ❑ es t,` No © Stxe ��� <br /> able ❑ Air ❑ r` \ester of bore 10" _ o <br /> \ <br /> m 50. 210 .� � -� <br /> r ❑ Bucket ❑ �lao] - <br /> CASING INSTALLED,r (8)PERFO Aw NNS ut U <br />,teel ❑ PlastcluC c Type of pe dq"n or'dze of screen - <br /> rom <br /> To,-_—,Dia r l~ To v - <br /> ft in Wall f ft 21'QN,"60 P 1561 21 1 '"x - <br /> WELL SEAL `` - <br />"as surface sanitary seal provided' les l$ No ❑ If yes, to depth 50 strata sealed against poll pnn� les ❑ No [X Interval 1t Uds <br /> of seaLn cement l\nrk start I9 Complet 79 <br /> IO) WATER LEVELS WELL DRILLERS STATEMENT <br /> th of first water of knoK ft Thu well was drtJled under myturrsdectton and this report is true to the best of milDAding level after well completion ft Knowledge and belief <br /> WELL TESTS SIG\EI) <br /> A as well test mdde� les ❑ MuNo If %es by whom? ON ell Dnller) <br /> T%Pe of test Pump ❑ Bailer ❑ Air lift ❑ r Paneizo Wte&* Drilling; Inc . <br /> ME__.. _-- -- <br /> xh to %at,r at start of test ft At end of test ft J, Person brm nr rnrpn tion) (T ed nr netted) <br /> Address_ 3145b f, Lone r'r@e 1fOaY <br /> al/nun after.,,_, hnurs Water temperature ^ 1 <br /> , 77yy�� <br /> analyses made l e+ ❑ No ❑ If es by whom' G'n Oakdale, Calif. 5 <br /> 2-6 <br /> rr�`f p 7 <br /> a 7 f <br /> electric loft made' Yes 0 No C3 If .es attach copy to this report Lfoonse No ate of this rgpn <br /> r" F <br /> R 168 (REV 7 76) IF ADDITIONAL. SPACE IS NEEDED USE NEXT CONSECUTIV[ NUMBERED FORM <br />