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ORIGINAL STATE OF CALIFORNIA Do not fill to <br /> THE RESOURCES AGENCY <br /> Ila with DWR DEPARTMENT OF WATER RESOUR%..,�.S NO. 060029 <br /> N o of Intent No 48p156q C WATER WELL DRILLERS REPORT shite Weil No / <br /> ` l[enntt No ur Dnte 78-1581^ Other Well No[_ ��t — <br /> WNER urine Dei Auch Cons t t. ( 1`?) WELL LOC Tuttl depih..�_tt lhpth of cnriipleted weil-1 U j <br /> k((rely 1359 Lincoln Blvd. front ft to it Form ittun (Derenht, by calor ch trader lire fir mnterinl) <br /> " TracY-a Cc7�l _ Lilt _.. <br /> 1 LOCATION OF WFLL 0 - 3 fine sand <br /> �� � {Ser w trtl Wells} 3 - 7 sandstone <br /> C ounN Yl Owni r s Well \umber <br /> (11 iddress it dtlferent Inner drove 7 12soft row ay'ti mhip R tnHe Sectio 29 a rd r a <br /> Di,taneu From wttes roads riilriinds Fences,etc - 34 course,sand and small rock <br /> 34 - 52 ra <br /> 52 - 0 `course hand and small rock <br /> 50 - 80 Soft gra clay tree roots & sm.roc <br /> (3) TYPE OF WORK , <br /> New Well [X Deepening ❑ <br /> Recrostructtan 0 — `\ <br /> iZ Reconditioning ❑ <br /> SI <br /> Horizontal Well ❑ <br /> Destruction ❑ (Describe — <br /> destruction materials art <br /> Procedures in Item 121 — - <br /> a (4) PROPOSED US <br /> Domestic <br /> Irrigation µ © — <br /> Industrial ❑ — <br /> Test Well ❑ — <br /> S tock ❑ <br /> Municipal Q <br /> WELL LOCATION SKETCH Other ❑ — - <br /> EQCIPMEN T (8) GRAVEL PACK " <br /> Rotarl & Reverse ❑ Yes)] NO ❑ Size t Ithle C1 Air ❑ Diameter of bo 14her C❑ Bucket ❑ Packed from ^to a` Ft <br /> (7) CASING INSTALLED (8) PERFORATIONS — <br /> rl l,] Plastic [ Corxrete ❑ Type of perforation or size of screen — <br /> Froin To Dia Gage or From To Slot – <br /> ft ft in Nall ft ft size <br /> 't - <br /> } WELL SEAL - <br /> as surface sanitary seal provided! les No ClIf yea, to depth —50—ft = <br /> ere strata sealed igainst pollution" les ❑ NX a Intenal R <br /> Method of seahn• hanti note tcarniant mix Work start I9 Complet 19 <br /> SO) WATER LEVELS — WELL DRILLERS STATEMEINT <br /> pth of fiat water if known –ft Ihrs well was drilled undo no <br /> a ,/ tvr diction d this report is trite to the best of my <br /> ndint; lesel after hell ctimpletio* R knomled" <br /> (11) WELL TESTS �/ SIG\)4 <br /> us well test midi° les l.f� No ❑ If vei h� whom? (W Driller) <br /> I,. of tcst Pump ❑ Fisher ❑ air lift NAME—Canada PUTTI S eS and Service Inc. <br /> einh to ti ttc at start of test ft At end of test ft (Person, flmi or corporation) (Typed or printed) <br /> // <br /> Dist.hirRe •ilnun <br /> after....,.LW______�saur. R iter temperatur Address Pin, Rox 990 <br /> Antioch , <br /> - – - <br /> -11 imdists made" Yes No If les, hl whom' City Antioch, Calif- – zip a4�� <br /> as IVM M soy; made' Yes ❑ No It %es ittach copy to this report License No 34289.3_ Date of this repo Nnv.1A <br /> B IREV 7 761 IF ADDITIONAL SPACE IS NEEDED USE. NEXT CONSECUTIVELY NUMBERED FORM <br />