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nAk W A 1 .CA W JM" 1JA1LLZiMb Al1'UKI Do Not Fill In <br /> RIG with DWR (Sections 7075, 7090, 7041 , 70421 Water Code) <br /> TH7E RESOURCES AGENCY OF CALIrUR'NIA o*NN 440 '70 <br /> DEPARTMENT OF WATER RESOURCES Stitt Well No. <br /> Other Well No. <br /> ( 1 ) OWNER: ( I l ) WELL LOG: <br /> Name Me EARL R08ERTS Total depth 132 ft. Depth of completed well it. <br /> Address PoOse 80X 241 Formation, Describe by color, character, fire of raareNal, and neerfure <br /> FRENCH CAMPaA IFORNIA ft. so <br /> ( 2 ) LOCATION OF WELL : <br /> County in Owner* number. it any 4 9 . <br /> Hard Pan <br /> Township, Range, and Section 26 C1 <br /> S y <br /> Distance from cities, roads, railroad., ate. E si gt of Highway504 26 2 8 San d <br /> 8 4Clay <br /> ( 3 ) TYPE OF WORK (check) : 41 4 <br /> New Well Deepening ❑ Reconditioning ❑ Destroying ❑ 1 <br /> ay <br /> It destruction, dercribe nrat<rial and procedure to Item 11. 45 73 Sand <br /> (4) PROPOSED USE (check) : ( S ) EQUIPMENT ; 73 IQQ <br /> Domestic ® Industrial ❑ MuniciPal ElRotary S] 100 107 Sand <br /> Irrigation E] Test Well E] 0th er ❑ Cable El132 <br /> ElOther 1117 12a ri <br /> ( 6) CASING INSTALLED : 132 y <br /> STEEL: OTHIM : If gravel packed <br /> SINGLEK] DOUBLE CI <br /> Gage Dimmest _ <br /> From To or of From To <br /> ft, ft. Diem. Will Bore ft, ft, <br /> 137 Sri #12 <br /> Size of shoe of well ring; <br /> ge 1/ 8 site of va6 <br /> Describes welded <br /> ( 7) PERFORATIONS OR SCREEN: Vvqirse r r <br /> Type of Persona or name of screenSh 3P <br /> Feel. Rows e <br /> From To per per Size <br /> tt. ft. row ft. <br /> ( 8 ) CONSTRUCTION: <br /> Wal a surface unirar7 ml provided} Yes ❑ No Q To whit depsh ft, <br /> Wereany estate waeld against pollution? Yea CINo 12 If yes, note depth of strata <br /> From it. to ft, <br /> From ft. to ft, Work started v 66 , completed 4 / 26 ,966 <br /> Method of Italian WELL DRILLER'S STATEMENT: <br /> WAof my knowledge and belief. <br /> TER LEVEL$ ; This well was drilled under my jurisdiction and ibis report is true to the best <br /> De th tar which ware* wu fish found it known it. -- <br /> Standing level before perforittes, if known fa NAME CIARK WE <br /> Standing level after perforating and developing it. (Parson, firm, or mrpoation) (TYfe orCraed) - <br /> ( 10 ) WELL TESTS: Address 2024 EAST CHARTER WAY <br /> �F&E test made* Yes [I No f6) If yes. bywltom? STOCKTON �..CayALI . ORNAI <br /> ' Ral. min. with . ft. drawdownafrat ha. S1oNnnl 1 7� <br /> Tem earvn of water Wee a Assures analysis made? Yes ❑ No (Well Driller) <br /> was electric log made ofwdD Yet C] No 01, Ures, etrachcopy License No. T6602 Dated April 26 19 66 <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> D W R 188 t REV. 9.901 46301-910 10-411 ease TRIP 0 A age <br />