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srAT2 or CAUPORNIA Do not fN in <br /> THE RESOURCES AGENCY No 216366 <br /> dile with DWR DEPARTMENT OF WATER RESOURCES <br /> t <br /> ' iae Iaeeat rtt, WATER WELL D�LERS REPORT state well No <br /> Fa!PetnSft No,or Dntc $-27^'87 Other 1Ye]I No.� !Y f�t,}1 <br /> (I) OWNER: ram 1MCCOrTI ck & Baxter (12) WLLL LOG: Totttl dapth_ A <br /> 253 .Depth of completed war!* 248 t. <br /> ' Address PO-Box 172$ from ft to ft Formation (Describe,by color, character, size or material) <br /> city Stockton CA 9520] zip 0 - S Gra S_1 i1Z <br /> (2) LOCATION OF WELL (Seeinstntetions): 8 - 30 Brom sandy Silt � <br /> County _ _ _ An .Toa f -�pwner a Well Number D'- - 30 - 4 Sold & Gravel <br /> ' VVe]E address if different from abov 34 - 60 Green C y W Saind <br /> TotiYmhip`t' R0.Aj{ 6 E ee=ia 60 - 0 Gray o-aV <br /> Distance from cities,roads,railroads,fences,etc '• <br /> w <br /> ,. ay- <br /> - <br /> pcZ7=130 Sari <br /> ' (3) TYrE OF WORK: a 2-� t <br /> Nem Well I)ecpening�] � � <br /> see map attached necaas=ruction © _ <br /> necanditioniog ❑ - <br /> ' Horizontal well <br /> Destruction ❑ (Dsscrilae '00`'•�+ `� <br /> destruction materfaI and J <br /> procedures in Item i2�y <br /> (4) PROPOSED VSE: ' J A` <br /> Domestic b \L <br /> Irrigation <br /> Industrial "�'• '��'e Q (.���� .,�� <br /> To f Well ❑ ,�`X13 �- <br /> tock <br /> ' WELL LOCATION &KETCHt <br /> sOhe�'IO1:'1Q�Or'ZT�X� <br /> (s) rQUIrMENT: {s) CHAVEk'll,4CK_ <br /> Ralary• <br /> Reverse <br /> [] Y t No{f� Siye <br /> .2 < <br /> Cable, C] Air 0 ',D%i�\Bfar of' bore <br /> Other Rocket ❑ - <br /> (7) CASING INSTALLED. rr��� (8) hILF'0IRAT16r+iS- <br /> Steelr� Plastic Cl Cono{etp j Type of perfoi.7"i or ais0 of screen i fir <br /> From To Z3ix. Gose=t rj Eroro�'_y u)To <br /> ft. ft. itt. <br /> WAR ft 3 It, <br /> ' `w%20•, <br /> (9) 'WELL SEAL: <br /> Was surface sanitary seal provided? Yeaa No 0 if yes,to depth74 ft, <br /> Were strata sealed against pollution? Yer(] No ❑ Interval rt. <br /> ' Method of aenlin {park started <br /> (30) WATER 7EVELS:: WELL DPJLL.ER'S STATEMENT- <br /> Depth of link .vaier, if lmo vn rL This well tons red undzr rayj ion rsnrl s report Is Irue to the best of my <br /> Standing level after well completion, _ - - h, knowledge a icf. <br /> ' (11) WELL 'PESTS- SIGN n <br /> Was well test mode? yes Q No If yes, by whom? (Well ri Qr) <br /> Type, of test pump O Hailer[] Air lift❑ ATAME I13dlr� d �7,�gr Inc. <br /> Depth to water of start of zest - ft. At end of test ft a n,Arm or co oration) (Typed or printed) <br /> Andres 1055erurlaa Carle <br /> Irargc „dol/mint after t+oujur '; Water temperature � O C Ur CA 96073 <br /> .Mlwl nta lysis made? -Yes 0 Noj�)1 If YES,'[)y whom? City- - - lip <br /> !`,rs electric lag made? " Yes Q'" No If yes,ottach copy to this report License No.ril 940,E Date of this rapn <br /> DWA 1138 IRZV.7.76) _ IF ADDITIONAL SPACE 18 NEEDED. LIS5 NEXT CONSECUTIVELY NUA 85RED FORM <br /> r <br />