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STATE OF CALIFORNIA Do Not Fill In <br /> THE RESOURCES AGENCY <br /> ORIGINAL DEPARTMENT OF WATER RESOURCES � ,ANO 94553 <br /> File with DW` <br /> WATER WELL DRILLERS REPORT Ssase Well No.i �E- <br /> E- <br /> Other Well No <br /> ( I) OWNER: (1 1) WELL LOG: <br /> Name State of California To[al J.pth R. Depth of completed well 315 f[. <br /> Address Formation: Desrribe by rofor,rherarler,si=r of osalrrial,end alntc?are <br /> fr. to ft. <br /> (2) LOCATION OF WELL: 0 25 Ypllnw Clay <br /> - <br /> ....Y5anJoaquin Owners number,if any <br /> rownsh,p,Range,and section 127 128 5and <br /> Distinct from cities,roads,railroads.etc. 1 ?Q 137 Blue ClRy <br /> Plymouth & Country Club 137 147 SAnd <br /> (3) TYPE OF WORK (cbeck): 147 160 Blue Clay <br /> New Well ® Deepening ❑ Reconditioning ❑ Destroying ❑ <br /> If destruchun,describe material and procedure in Item 11. <br /> (4) PROPOSED USE (cbeck): (S) EQUIPMENT: 170 ISO Sand <br /> Domestic ❑ Industrial ❑ Municipal ❑ Rotary Fil inn 235 Blue Clay <br /> Irrigation ® TestWell ❑ Other ❑ Cable ❑ <br /> Other ❑ 252 265 Rlue Llay <br /> (6) CASING INSTALLED: <br /> STEEL: OTHER: If gravel packed <br /> 272 296 Rlue ClaV <br /> SINGLE [jt DOUBLE ❑ <br /> Gage Diameter 313 315 Blue Clay <br /> Feorn I.0 or ofFrom To <br /> ft. It. Diam. Wall Bore ft. ft. <br /> 0 22 25 29 <br /> E =r=r 0 1 B 0 315 <br /> Size of shoe or well ring: 1 4 1 a t e siz of Qr.—I: <br /> Dexribr iuinl <br /> (7) PERFORATIONS OR SCREEN: <br /> Cypc of perloratiun ur name of screenLouvered &, Ful—f l o <br /> Perf. Rows <br /> From To per per Size <br /> ft- ft, row fr_ in.x in. <br /> 215 2-9-1 <br /> 297 -115 <br /> (s) CONSTRUCTION: C <br /> Was i sod=a sanirary seal provided? Yrs N. D To who[depth 5 0 fr. <br /> Were ane.uaw.t=ied agai nsr poi:otion? Ycs ❑ No[g, If yrs,note depth of stnu <br /> i-ro it.to ft. <br /> From fr. to ft. Work s[arred. 19 ,Completed 19 <br /> .M.,t .d of,..ling WELL DRILLER'S STATEMENT: <br /> (9) WATER LEVELS: This well was drilled ander my jurisdiction and this report i, true ha the best <br /> of my knowledge and belief. <br /> Uep[h a[ which weer was first CaunJ, if known f[. <br /> standing level hchn perfnrari,g. if known 1r, NAME Clark Well & E ui ment Co. <br /> Standing level if,., perfnn[ing and de-eloping F[. <br /> (Person,firm,or corporation) (Typed ar primed) <br /> (10) WELL TESTS: Address 2024 East Charter Way <br /> {a,pump r.tt made? Ye, Na a f,u,. y whom? P .G. & E Stockton C A 5 2 0 6 <br /> 82 Kai./min,with 40 f[.Jnwdown ai ter hn. [ IGN EL)] <br /> S <br /> �.y� �! y <br /> 1emp......e of_.E" Was a chemical analysis made? Y's UX No ❑ 14Vr!!Driprr) <br /> >wa,elerrrir log made of well? Ytet': No - If tea,attach copy License No. 76 6 02 Dated 11 �.JU ly 1972 <br /> + SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> 2 <br /> OWR 188 ?REV. 9-aelA <br /> I3179-970! ____,., rnlP Qb O5P <br />