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ORIGINAL STATE OF CALIFORNIA Do not dill in <br /> File with DWR THE RESOURCES AGENCY <br /> DEPARTMENT OF WATER RESOURi. r1S No. 060033 <br /> y� a of Intent No, 148160 WATER WELL DRILLERS REPORT State wall Nil. <br /> l timmit No. or Dnte 78 - 1587 <br /> Other Well Nn, <br /> ( t ) OWNER : N ( 12 ) WELL LOG : Tnhd depth 81 ft. Depth of co,npleted well 78 it, <br /> Address, 1369 Lincoln Blvd fere ft. t, rt. Formation ( DeseHne by color, chs <br /> cby Tracy , Calif . 95376 _ chant size materiel) <br /> zip <br /> ( S ) LCATJON OF WELL ( Seeinstroctiots ) : 0 - 3 fine sand <br /> oaqul n _ G,emeta Well \lumber. 3 - 10 sandsto <br /> ns <br /> %Veil address if different from above 508 E . Watters Rd , 10 - 14 soft bro and gray ela,y. mix <br /> T'nrmshho Ranq • Secdm 0 <br /> Metallic from cities, mads, railroads. fences, etc. 31 - $ d r0 k <br /> - r <br /> 52 - 60 ' course sand and small rock <br /> 60 - 71 ` jay c I ay <br /> u ( 9 ) TYPE OF WORK; 71st 75 'NKy I and tree root and sm rock <br /> New Well f Deepening. ❑ 75.,, . ' 80 ray clay <br /> yS' Reconstruction ❑Reconditioning <br /> st <br /> / ? Horizontal well ❑ . �.'• - , `\�� r,,, <br /> �[\ de radion ❑ (Describe = V - <br /> 'J \ d stmetlio materials t <br /> procedures In item IZ <br /> t O� ( 4 ) PROPOSED bSEr _ <br /> Its Domestic ��( <br /> a [rrigaHnn ❑ _ - <br /> AIndustrial ❑ - <br /> Test Well ❑ _ <br /> Stock Cr - <br /> Municipal ❑ - <br /> wELL LOCATION SKETCH - •Other ❑ <br /> ( 3) EQUIPMENTe ( 8 ) GRAVEL PACKi - <br /> Rotary 6 Reverse ❑ 'Yes 6 No ❑ Sis., 14 " ea _ <br /> 14 " <br /> Cable ❑ Air ❑ ' Diameter of here - <br /> Other ❑ Bucket ❑ Parked from 50 ar 81 fL — <br /> 17 ) CASING INSTALLED: ( 8 ) PERFORATIONSr - <br /> Steel ❑ Plastic Ex Concrete Cl Type of perfmatinp or size of screen - <br /> rwin To Dia. Gage:iyr From To - .Slog <br /> ft ft. : in. . 44'x11 ft, : '. ft. sue ' - <br /> 0 61 ' 6 " 61 81 - 1/ 16x2# - <br /> ( 9 ) WELL SEALI NV <br /> Was surface sanitary seal provided? Yes 0 No ❑ If fres, to depth_ ; 0 ft, - <br /> Ways strata sealed auuins't wdlulinnP Yes ❑ No p Interval ft. - <br /> 6lathed of senhn • e 0 i e ere 1 Work started 19 Complete 19 <br /> ( l0 ) WATER LEVELS : WELL DRILLER'S STATEMENT: <br /> Depth of Inst water, if known ft. This well was drilled under Iv iuix cHnn this report Ix true to the best of amt <br /> Standing level after well completion ((• knowledge y� belief. <br /> ( 11 ) WELL TESTS : - SIGNED— Qti <br /> Wai well test made? Yes y No ❑ If yes, by whom? a d II Drill r) <br /> Type of test Pump El Boiler ❑ Air lift Cana a Pun Sales and Service , Inc . <br /> � NAME <br /> . Can <br /> to�water <br /> tt �tt start of test f * At end ore <br /> f test ft ( Person firm or corporation ) ( Typed or printed) <br /> Disebarau]fLS* aalimha ofter_L_honm - Water temperature Address P . 0 SOX 990 <br /> ( <br /> and amny.h InaaeP Yea ❑ No 0 If ye , by wnm„? stir Antioch , Calif , zip 94509 <br /> Was electric Ing made? Yes ❑ No 0 If yes, attach copy to this report License No, 342893 note of this report 11 / 17178 <br /> OWR 188 epee, 7,761 IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />