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UQDRU191.1CATE STATE OF�ALIFO_^.NI%RU <br /> �I� A Do not fill in <br /> ;se to comply with THE RESOURCES AG11 `nIcctl requirements DEPARTMENT OF WATER Oa ,3cN\- 10. 128696 <br /> -ice of Intent No. WATER WELL DRILLERS REPORT .{ tv <br /> P� G Ij e, Nn <br /> ^val Permit No. or Date N 1O N e�'Other Well No. <br /> b?) OWNER: Name T & {T] MUCKING RUDY (12) WELL LOG: Total depth-22-0-ft. Depth of completes welt 180 ft. <br /> Adress 12396 it• wy 97 From ft. to ft. Formation (Desby color, character, size or material) <br /> LODI3 CA Zip_ -- - psocribe <br /> I"-) LOSCAAW1 �O�ffPLL (See instructions): _ ay e <br /> :ounty d tJP _--Owner's Well Number__..___- <br /> 12 sand <br /> :11 address if different from above 12 - 37_ aY e <br /> `as•nship Range Sectio - _ Shale <br /> )istance from cities, roads, railroads,fences,etc - 54 p <br /> - - ✓ & s <br /> rzle <br /> FRONTAGE ROAD -. I MILE NOTH OF M - 61 Sand <br /> 30AD — EAST SIDE 61 - , O Clay'-,bw . <br /> 90 - 77 Sand <br /> (3) TYPE OF WORK: 7,,52' �C, .a <br /> New Well J$ Deepening ❑ 0 Sand^& Shale <br /> bw Reconstruction ❑ 80 -NMI Sha te, <br /> Reconditioning ❑ - 18 5 C74 �..� <br /> Horizontal Well _ ❑ <br /> Destruction ❑ (Describe - <br /> bIll destruction materiak A <br /> procedures in Item - y le $� <br /> (4) PROPOSED 997, Sbale/& lelay <br /> Domestic 106 - S ha 3,0, �\ a t1 <br /> Irrigation - 1 Cie <br /> Y` <br /> Industrial �✓ 118t�'at n�`-,ScWell ❑ � - 1 U .S nd <br /> sty 1I - > ga�id Coarse <br /> Mumcmp 136 <br /> WELL LOCATION SKETCH / Other !1 ❑ 1 ! -^ Sand <br /> `) EQUIPMENT: (6)YYGRAVEL�PACK. {(� 1 � a & Shale <br /> Rotary $ Reverse ❑ yes£1 No 9Q Siz D+'� e ,� � 160 Sand & Shale <br /> .ble ❑ Air ❑ '•��D,`e�of bore /^'� - MAY <br /> her ❑ Bucket ❑ Pa, ed`from to \\\165 <br /> �\ 6 - <br /> (7) CASING INSTALLED ((��'��\� (8)PERFORAEI i TIS: � - 20 e <br /> �'•^el iA Plastic CO) C te Type of perft'iiaticjn orr ize of screen 2 204 Sand Fine <br /> - <br /> Froin T Dia. Gago-or F 10 � Jt To Sle2C4— eSans <br /> ft. ft >in. Wall f . ft. s 2 8 — 1a Shale <br /> D t _ <br /> (9) WELL SEAL: <br /> as surface sanitary seal provided? Yes'. .+ No$[ If yes, to depth ft, - <br /> 'ere strata sealed against pollution? Yes ❑ No ❑ Interval ft, - <br /> Method of sealing- Work started J11niF 19 Como& ii T 19 <br /> 110) WATER LEVELS: 0 WELL DRILLER'S STATEMENT. <br /> epth of first water, if known ft. This well was drilled under my jurisdiction and this report is true to the best of my <br /> anding level after well completio*, R, knowledge and belief. <br /> (11) WELL TESTS: SIGNED <br /> Was well test made? Yes ❑ No Z If yes, by whom? (Well Driller) <br /> rpe of test Pump ❑ Bailer ❑ Air lift ❑ NAME TrERNTMOR BR S- DRILLTNG CO.. INC- <br /> epth to water at start of test ft. At end of test ft3525`Person firm,a co oration) (Typed or printed) <br /> Discharge gal/min after hours Water temperature-­1Address <br /> PeYanda�e Avenue <br /> Calif. Z; <br /> ^he�nical analysis made? Yes C3 No Q[ If yes, by whom? City Modesto, p 95350 <br /> las electric log made? Yes ❑ No If yes, attach copy to this report License No. Date of this report <br /> DWR 188 (REV.7.76) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />