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®19KGINAL STATE OF CALIFORNIA Do not fill in' <br /> Vit THE RESOURCES AGENCY nI <br /> File with DWR DEPARTMENT OF WATER RESOURCES No. 178135 <br /> P' of Intent No. WATER WELL DRILLERS REPORT State Well No. <br /> 1 'omit No. or Date 5 5 3 S Other Well No.o2S404-l5230P <br /> (12) WELL LOG: Total depth 4 0 Oil. Depth of completed wel 3 3 0 Ft, <br /> from ft. to ft. Formation (Describe by color, character, size or material) <br /> o --1 Ton Sn i 1 <br /> (2) LOCATION OF WELL (See instructions): 3 -7 C I ii <br /> County San O o a qui n—owners Well Number 7 -12 Sand <br /> Well address if different from above �0 <br /> Township TRACY -Hang e Sectio 30 <br /> —39 San� <br /> Distance from cities,roads,railroads,fences,etc, <br /> 39 -65 C I aV�, <br /> n d %'� <br /> south side ax <br /> 17�i-Pn_q 016A <br /> (s) TYPE OF WORK- 2 0 5/21 2 B 1 ul? San d <br /> New Well EX Deepening ❑ 2A 7",L iipt <br /> Reconstruction ❑ <br /> Reconditioning Q — Q_J _�> <br /> Horizontal Well Q ��� 4 <br /> Destruction C7 (Describe `l 4 —2 C li" f'' <br /> destruction materials �-{' (1�q // <br /> procedures in Item I,� 2,y 8 -2 9'kt,S e t- Sand <br /> (4) PROPOSED Skly, 299 2'N9,$i n e Set/\Sc'1b'E1 <br /> Domestic ° 31 9 -40 O�G 1 a <br /> Irrigation ❑ <br /> Industrial 4 } ❑ ���".,�✓ � <br /> T st"Well ❑ <br /> Stec <br /> cl v <br /> Muni <br /> -_r , <br /> WELL LOCATION SKETCH '��/ Other Q <br /> (5) EQUIPMENTi '(8) GRAVitiL�PACK: S( �d\ �,— <br /> Rotary Reverse ❑ ^, e � No [� Size 'O _ �ti��1✓_J <br /> Cable ❑ Air ❑ Djndtaeter of bore vj— <br /> Other ❑ Bucket ❑ <br /> (7) CASING INSTALLED:j •, (8)'PERFOAR�A^flI0 — <br /> Steel❑ Plastic ] Cor�gpbte Type of perf'iat'an or`sze of screen�!^+�; <br /> From To ,Dia. Gaffe of Fr4�, Sly <br /> ft. ft.�•, /In. Wall ft ` ft. <br /> 1200 16 160 1 <br /> (} 1 <br /> Was ce s t ry sea rov anYes)(3 No Q If yes, to depth � O" R. <br /> Were strata sealed against pollution? Yes ❑ No Q Interval Ft. — <br /> Method of sealing }Q Work starters ,1 I I fl P rl 19 B-5_ Completed 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if known ft This well was drilled under my i r(sdiction and this report is true to th est of my <br /> Standing level after well completion S 6 ft, knowledge and belief. <br /> (.11) WELL TESTSi SIGNED <br /> Was well test made? Yes ❑ NnA iFIf yes, by whom? (Well Driller) <br /> Type of test Pump El ``Bailer(3 Air lift ❑ NAME H E N N I N G S BROS . DRILLING CA <br /> TNG_ <br /> Depth to water at start of test R �' r t At(endf-of test / ft (Person,firm,or corporation) (Typed or printed) <br /> Discharge oal/ruin after hours Water tt'e�mpemhtref Address 3525 P E AND lLE A V F _ <br /> -a1 analysis made? Yes ❑ No)/ If,yes, by whom? City r.�n n F s T o s ( Zip C, F 6 <br /> . electric log made? Yes ❑ NO)a If yes, attach copy to this repot License No 2-Co Data of this report_- 5 <br /> • DWR 188 (REV.7.70) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />