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STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill in <br /> ' File with DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT N0. 2 u 113 3 <br /> ' tice of intent No State Well No OZS SSC l <br /> Local Permit No or Date 87-2019/.2020 Other Well No �q <br /> (1) OWNER Name Moorman I s Water S Stems (12) WELL LOG Total depth 190 ft CAimpleted depth 185 ft <br /> Address 2120 Wilcox Rd . from ft. to ft_ Formation(Describe by color character size or material) <br /> ' city Stockton , Ca ZIP 95205 - 4 <br /> Top 5011 <br /> (2) LOCATION OF WELL (See instructions) 4 - 10 Sand <br /> County San J o a qu i n Owners Well Numbin — 43 Clay <br /> er <br /> ' Well address if different from above 660 Acorn Ct. ohn Re 1 n 4 <br /> Township Range Section 45 — 52 Clay <br /> Distance from cities, roads, railroads, fences,etc 52 - <br /> 80 Sand <br /> ' 80 - 118 Clay <br /> / , v <br /> 121 - 12 <br /> (3) TYPE OF WORK 126 - 1 <br /> New Well CX Deepening ❑ 138 - 142 <br /> Reconstruction ❑ 142 - x'4,6 S ctnd <br /> ' 'Reconditioning ❑ 146 9 C --_ <br /> Horizontal Well ❑ 149 - 1 \ aand " <br /> Destruction ❑ (Describe <br /> destruction materials and pro- 180 Sand - <br /> ' cedures in Item 12) x/19 1 C 1 ay- <br /> (4) <br /> (4) PROPOSED USES <br /> Domestic _ <br /> Irrigation ❑ _ <br /> ' industrial / `�\ ❑ <br /> Test Well ❑ <br /> Mumcipar ❑ _ <br /> Other ❑ -WELL LOCATION SKETCH ,t <br /> (5) EQUIPMExxNT (6) GRAVELPACK S�a�-±n u <br /> ' Rotary Reverse ❑ Yes Q§ No © _Siz2a r V _ <br /> Cable ❑ Air ❑ Diameter of bore �I <br /> Other ❑ Buckej--Z} Yacf�ed roF m 55 b"185 € — <br /> 1 <br /> 'rYti v I.e - -v <br /> (7) CASING 1NSTALUD� 1 (s) PERFC <br /> 64ATIQNS /1 <br /> Steel ❑ Plastic l� pori a Type of rperf�oration or size of,16peo✓�� <br /> From D Gage orrn <br /> ' ft 4, iL. Wall Ft-' ft' /size = <br /> 0 185 160 165 485Scree <br /> - <br /> , _ <br /> ' (9) WELL SEAL ,�i� S 5 <br /> Was surface sanitary seat provided? Yes Cx No ❑ If ter,m depth ft — <br /> ' WtrestrataseiledagauistpullutluO Yes ❑ 10 ❑ Interval ft — <br /> Method of sealing Bentonite Wnrk started r1 11 n e 8 19a7— Complcted 19 <br /> (10) W4TER LEVELS WELL DRILLERS STATEMENT <br /> Depth of firstwater if known ft <br /> ' _ This icefl rim clnlled under m jurisdiction and this report is [rue to the <br /> Standing level after well completion _ 72- ft btst of my knouled a and belief <br /> WELL TESTS } <br /> ell test made Yes ❑ No 91 IF yes by whom I 1 -J fWell Drill <br /> ' oFtest Pump ❑ Briler ❑ Airlift ❑ NAMF HE-NNINS BRO1.9,'DRILLTNr,,rn TUr <br /> - <br /> ath to water at start of test ft it t nd of rest ft (Person firm or corporation)(Tv ped at printed) <br /> Discharge m gal/mafter Address . 352-5, 1 ANDAI E AVE <br /> hours Water temperature p <br /> Chemical analysis made" Yes ❑ No K3 If yes,by whom? City UE S T 0„a,,,,C,A ZIP 9539G <br /> Was electric Ing made Yrs ❑ No KI If ver,attach copv to this report License No - 290813 Date of this report 19 <br /> ' IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br /> DWR 188 rREV 12-861 B4 963213 <br />