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vivasenaa>L W AA 1 Z1C W 1:LL "RUj Er1KJ K LI-lVK.I Do Not Fill In <br /> file with DWR (sectlona 707.9,7040,soil,70t2,W.t.r code) <br /> THE RESOURCES AGENCY OF CALIF tjRNlA c�NA 44 O <br /> DEPARTMENT OF WATER RESOURCES Sts well No <br /> AZ :57Other well No <br /> i,ame <br /> OWNER (I1) WELL LOG.M R e EARL ROBERTS Total depth ft Depth of completed well ft <br /> ' Address P O SOX 241 Formation Describe by color,rberacur,size of rneiers.l,end seraeinrr <br /> F C ramp C FOR I A fr to ft <br /> (2) LOCATION OF WELL <br /> County 4 V �, Owner s number if arse Q 9 Hard Pan <br /> Township Range and Secttoa r 1� r� 9 26 Clay <br /> Elutants from cities made,radraads etc F;*S 0 I 1 �!1411 5 U 26 28 Sand <br /> — North rvf Rn+h aged 500 ft. s 41 Clav <br /> I (3) TYPE OF WORK (check): 41 43 sal3d <br /> New Well ® Deepening ❑ Reconditioning ❑ Destroying ❑ -43 45, Clay <br /> If destruction,describe material and procedure in Item 11 45 73 5and <br /> (4) PROPOSED USE (check). (f) EQUIPMENT: 73 100 Clay <br /> Domestic ® .Industrial ❑ Municipal ❑ Rotary KI iaE 7n7 Sana <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable ❑ 107 121 C la y <br /> Other ❑ 1-23 132 Snnd <br /> (6) CASING INSTALLED: 1.32 <br /> STEEL OTHER If gravel packed <br /> 911411EEDOUBLE <br /> Gage Diameter <br /> From To or of From To <br /> ft ft Dum Wait Bore ft. ft <br /> 13.7. 1 n #12 <br /> of shoe ar well rine 1/8 Ssae of,travel^�—e <br /> (7) PERFORATIONS OR SCREEN: <br /> Type of perforais a or name of screen Sh 30 <br /> ' Perf Rows t <br /> From To per per Size <br /> it ft row it in x in <br /> 111 131 x I <br /> ' (s) CONSTRUCTION. <br /> Was s surface sanitary seal provided? Yes ❑ No To what depth it <br /> Were uq strata sealed against pollution? Yes❑ No la If res nom depth of strata <br /> From It to ft <br /> From ft to it Work started 4 2 5, 6 6 ,completed 6l9 6 <br /> ' Method of seating WELL DRILLER'S STATEMENT <br /> 9` WATER LEVELS; This well was drilled under my Jurudwhon and this report is true to the best <br /> of my knowledge and belief <br /> Depth at whteh water wit first found of known it - <br /> Standing level before Perforating if known ft NAME <br /> Standing level .face pttforikrtjt and develo sn ft <br /> (Parson firm oreorporation) (Typed arprssred) <br /> (10) WELL TESTS: Address 2024 EAST CHARTER WAY <br /> mp test made? Yes ❑ No ® If yes by wham? STOCKTON CALI/ ❑RNA I <br /> sal Imsn with ft drawdawn after hrs [SIGNED) F� ,f <br /> Tsmperatun of wiser VISA ehanmsl analysis made? Yes ElNo W (well Driller) <br /> L <br /> electric los made of..11? Yes ❑ No If ret attach ropy License No- T6 602 hated. - April 26 __r 19 9--k6 <br /> ' SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 188 (REV 9 6e? least 950 10 40 sow rittPIDA,osi• <br />