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ORIGINAL STATE OF CALIFORNIA DO not fill in <br /> THE RESOURCES AGENCY <br /> Ile with DWR DEPARTMENT OF WATER RESOURl_ES No. 060031 <br /> �1 ' of latent Num 816$____14WATER WELL DRILLERS REPORT ,t,te NX ell No <br /> 1'cni7� <br /> t No or Datc _ Other 1�ell No <br /> J.ar � Deel Auch Cons et. CO. (12) WELL LOG Tut1l del),1,81 ft Depth of completetl well 78 It <br /> tldre,r 1369 Lincoln Blvd. tram ft to Et Formation (Describe by color ehirirter rite or material) <br /> t� Tracy, a i f, zip - <br /> 2) LOQ ATIQN Of WELL (See ulatmt-tio ib) 0 - 3 fine Sand <br /> (,inti a n O a (I1 n G C r� 1Ivell Number <br /> ell address if different From sho652 <br /> ve E. Watters Rd 12 fine- sand�� <br /> - <br /> ntu,hap Rsantc Sec nun Lot #4 12 - 50 qray caly art -brown sandy clay <br /> Distuice from cines roads radroad, fences etc 50 - 58 c0 r and and small rock <br /> 58 - 79 light ,a0-,dark gray clay <br /> - small rQck tree roots <br /> N (3) TYPE OF WORK <br /> New Well [X Deepening ❑ `� <br /> ti <br /> GReconstruction O - \ `\ , <br /> Reconditioning ❑ <br /> ro+'V I •-�+ <br /> f� <br /> Horizontal Well ❑ .moi,�1 - ��1 <br /> Destruction ❑ (Describe <br /> destruction materials an-d <br /> procedures in Item 12 k' - <br /> (4) PROPOSED USE� — <br /> Dome4tic - <br /> Irrigition ❑ - <br /> PIndustrnl ❑ _ <br /> !I Test Well ❑ <br /> QIt'c'l� - <br /> Snxk ❑ <br /> Municipal ❑ - <br /> O� WELL LOCATION SKETCH Other ❑ - <br /> EQiJ1Ph1ENT (8) GRAVEL PACK - - <br /> Rotary Q Reverse C] Yes [( No ❑ Size 4 pea <br /> - <br /> 1lite nn❑ Aar ❑ Diameter of bore '- - - <br /> her El Bucket Packed fmm to I Ft <br /> (7) CASING INSTALLED (8) PERFORATIONS - <br /> el ❑ Plastic til Concrete ❑ Type of perforation or size of screen - <br /> Froln To Dia Gage or From To Slot <br /> ft ft in Wall ft ft size — <br /> 6 6 <br /> WELL SEAL <br /> as surface sanitary seal providedL) Yes Nu C] If yes, to depttti_S0 ft <br /> ere stmta sealed against plillution" les ❑ No 3 Intend ft <br /> dl <br /> hlethtof seahn bentinote cement mix Rork stirted Nov 14J918— completed 197Q_ <br /> WATER LEVELS YELL DRILLERS STaTEX1EL\T <br /> of first water, if knunrL R Thir well was drilled under my 4�' <br /> tion a thrr report is trite run the best ni my <br /> jopt)h <br /> ndsng level after well completion ft hnowledue and beiuf c <br /> 11) AVE tL TESTS Sloan <br /> �s ,tell asst mrde' Yes Vu ❑r if yes, h) whont° eller) <br /> Bailer ❑ -kir lift CX <br /> klhofto <br /> testPump 1jN1�1 water at start of test tt At end et test tt P.O.(Fgs C `LJ�`l�� <br /> fip dr corporation) (Typed or print <br /> 0m,harSe 3d �al/tnin itter�_hours Water temperature Address <br /> iunalyYis rides les cj No If vrs by w$uni° City Antioch, Calif. -ZIP 94509 <br /> 1A.0jectric. log made° Yes ❑ No If%e3 attich copy to this report License No 347A4-1 -- Date of this report <br /> OW 8 (REV 7 76i IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />