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LOCATION NOT CHECKE. <br /> NATER WELL DRILLERS REPORT Do Not Fill In <br /> FileIOINAL O <br /> File Original,Duplicate and Triplicate with the (s.ati.mt 7076,7077,yon:,'Water tea.) 34964 <br /> REGIONAL WATER POLLUTION <br /> CONTROL BOARD No <br /> STATE OF CALIFORNIA r �} State Wall - <br /> rr, Ocher Well No.- `f__ — F <br /> f•.-flnrers■ppropri.fe nM.ab.r) --- <br /> 1) OWNER: (11) WELL LOG: <br /> Name Club Total depth Ilio ft. Depth of completed well 140 fe. <br /> Address 2705 County Club Blvd. Formation: Dert+ibe by color,cbmcler,size of m■rerld,awd itrwrlrre. <br /> Stockton, Calif. _ ft.to 5 Et. <br /> Top qnil <br /> (2) LOCATION OF WELL: <br /> Cnntyowner',number,if any-Uin <br /> �.Y -- Arn*afn r'i ajT <br /> R.P.D.or Sereer No. J 7 - 32 Rrnwn - <br /> 73 Gra y sa7 nd <br /> 73 75 Blue clay <br /> (3) TYPE OF WORK (check) 75 -._- 93 Aray sand <br /> New'well 6 Deepening ❑ Reconditioning ❑ Abandon ❑ 93 118 Blue clay <br /> if abandonment,deseribe material and procedure in I tern I I. J$ 120 _Gray sand <br /> (4) PROPOSED USE (check): (5) EQUIPMENT: 120 135 Blue c1,ay <br /> Domestic ® Industrial ❑ Municipal ❑ Rotary ® —13 5 140 „ GrU sand <br /> Irrigation ❑ Test Well El Other El Dug <br /> ❑ <br /> Dug Weil ❑ <br /> (6) CASING INSTALLED: If gravel Packed „ <br /> SINGLE❑ DOUBLE j] Gale • •• <br /> or Diameter from to <br /> From c.to ft. AtiDi2m.. I 2gnv.ll of Bon ir. ft. „ <br /> Type and Sze of shoe or well ring Size of gravel: ., <br /> Describe join[ •• •' <br /> (7) PERFORATIONS: <br /> Type of perforate-used <br /> Size of perforations in..lemmth,bjr in. <br /> From f[.en fa. Per(.per row Rows per it. <br /> (B) CONSTRUCTION: <br /> mat c amrfae■a 1342Yy s■d provided? ❑ Yes 0 No To what depth ft, ,• „ <br /> Were any strata ceded a5aiust pollution? ❑Yet ❑ No if yes,mote depth of strata ,. �• <br /> From ft.to it. <br /> Method of Sealing =q - 'Tkh scarred 1-24 19 Compl■wd 1-2 <br /> 1 19 <br /> (9) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> This Weil was drXed mrider my jurirdfctlon and Ibis rrpvri is true to the brit o <br /> Depth at which water was first footed 1(j-L, f�, It• my,knowledse and belief. <br /> I_[j[.:,._�---died level before perforating E[• NAME. - TOCi ii rr <br /> .ding lcvel after perforating Y. t__,. iPerwm,firm,or corparauo 1 (Typed or per■r.I) <br /> _ . 1►ddrws 646 South Ca lifornia St. <br /> (10) WELL TESTS: <br /> Aria a pump mat made? ❑ Yet ❑ No If yrs,by whom? <br /> [5rcx>3o].—_ --- -- -- �f-sic - -- — ' <br /> Yield: gel./nim. with it.dew dmvn after her. 7r11 n <br /> 7anperaturt of rust <br /> Was■chemical sodyaia mad.? ❑ Yn ❑ No 67850 <br /> License No.— <br /> W..electric log,Wade of well? 0 Yes 0 No a■aaf 3-e4 VOM QUIN 0 er•o DWR FORM No.240 (REV. 7.64) <br />