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ORIGINAL STATE OF CALIFORNIA DO not ftjx in <br /> THE RESOURCES AGENCY <br /> e with DWR ,AEPARTMENT OF WATER RESOURCES NO. 060030 <br /> of Intent No-L41151 WATER WELL DRILLERS REPORT St tte Well No <br /> cnnit No or Date Other Well NoIS _r - <br /> WNER x,,,ie Dep] Auch Co tt Co ( I2) WELL LOG Tut it depth -ft Depth of completed wet ft <br /> dreg 1369 Li neol n $1 Vd. fruit ft to ft Formation (DesCnhe b% LNtlor chanrc.ter size nr material) <br /> Trac Calif. Zip 95376 - <br /> 1 LOCATION OF WELL (See inatutt.t101u) -1 sandstone <br /> (.wont% Qw er s NVc11 Nu bee - <br /> iddregy if dttterent From tbove ryr� - brown Sand <br /> UIrbip <br /> R tngc Section GZ clay mix r., '., <br /> Dtstince from cotes Mad, r,,Imads fences, etc 50 - 5 �' sand <br /> 57 - 76 1 i Nt>i ld dark gray clay with <br /> two tricks of fine sandstone <br /> (3) TYPE OF WORK <br /> New Well [j( Deepening ❑ <br /> Reconstruction © _ <br /> Reconditioning ❑ <br /> tot yHorizontal Well ❑ <br /> 7t t Destruction ❑ (Describe <br /> destruction matenals and <br /> procedures m Item IZ <br /> il�cV (4) PROPOSED USE.' - <br /> '�h�� � Domestic w <br /> I rrwation ❑ <br /> Industnal ❑ - <br /> Test Well ❑ - <br /> Stock ❑ - <br /> hluntrepal Q - <br /> WELL LOCATION SKETCH Other ❑ - <br /> (3) EQIIIPNIENT (8) GRAVEL PACK - - <br /> otan 6 Reverse ❑ Yes d( Nu ❑ Size - <br /> hle ❑ Air ❑ Diameter of bore u _ <br /> cr ❑ Bucket ❑ P tcked from A�Q to t - <br /> (i 1 CASING INSTALLED (8) PERFORATIONS - <br /> el ❑ Plastic 6 Cancrcte ❑ Tvpe of perforation or size of screen - <br /> Frolil To Dia Gage or From To Slot - <br /> ft ft. in Wall ft ft Sita - <br /> n57 77 AITF;x2jR _ <br /> } WELL SEAL <br /> s surface sanitary seal providedO Yes No ❑ If yes, to depth�Q ft <br /> ere stntl Belled njltnst pollutinn' Yes ❑ Nok— Inter%tl ft <br /> Method of sealin U ork start 1 Completed 19 <br /> i)) WATER LEVELS VVELL DRILLERS STATEMENT <br /> pth of first water rf know ft Thir tied %as dolled un er mlr turisdi and this report ig true to the best of my <br /> Standing level after welt completion —ft ktwmIe&,c elref+ <br /> 1) WELL TESTS SIGNED— <br /> n wall tut modes les No ❑ If yes, by whom' Canada Veli Dnller) <br /> {>e ,f test Pump f^ Hader i] Air lift NAME— Z.nc- <br /> Depth to waterer at st ort of test ft at end of test ft t Person, firm or corporation) (Typed or printed) <br /> t+�hart[e ltal,mon after- hours Water teniiieratuxe Addrebb— P-0. Rnx 99 <br /> al analysis made? Yes ❑ 4o 6 iff Antioch . Calif. 9450R_ <br /> Yes, by whom+ CitY�i�ep� <br /> s ettnc log radia Yes ❑ No If %es attach copy to this report Licetue No 342893 Date of this repo ( <br /> D <br /> 8 (REV 7 761 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY ]NUMBERED FORM <br />