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' Do not fill in <br /> ORIGINAL SPATE ort CALIFORNIA <br /> THE RESOURCES AGENCY 216102 <br /> ] �+ O n <br /> le with DWR DEPARTMENT OF WATER RESOURCES No. L v L <br /> f Intent No WATER WELL DRILLERS REPORT State Well No <br /> ermet No or Date Other Well No <br /> 1) OWNER Nam (12) WELL LOG Total depth2 4 5 `t Depth of completed well ft <br /> Address P 0 U O X 1728 from ft to ft Formation (Describe by color character s--. or material) <br /> Stockton Ca i0 -32 park BrQjqn Dense Clay <br /> p <br /> 32 -75 Blue C] ay <br /> 2) LOCATION OF WELL (See instructions) 7 _ <br /> County Owner s Well Numbe # 1 <br /> 90 Sand & Clav <br /> d dif(rrent from above S S 9 0 -1 4 5 Sand 4 O pe- some <br /> � <br />[ell.address <br /> C a <br /> wship <br /> N Rant[e 5 E Sectio 14 5 -18 3 C l a Dark g n a e 81 u e <br /> Distance—fro11 1 1 mads railroads fences, etc <br /> 183 -224 San Grave 1 -C 1 a <br /> 224 -245 San r a v <br /> t I 1 1 P� 'i n 7 4 T r P m 11' 4XLIL� <br /> '1�4wn lip - <br /> (3) TYPE OF WORK -/:> <br /> New Well ❑ Deepening <br /> Reconstruction ❑ - .7 <br /> Reciendetioning ❑ <N <br /> Honzontal Well ❑ <br /> Destruction ® (Describe <br /> destruction materials ands - 1i <br /> procedures in Item <br /> (4) PROPOSED <br /> Domestic ` U - <br /> � J <br /> Irrigation <� <br /> See Map Attached Industrial ❑ - <br /> Te�,t,Well ❑ ♦ y <br /> Stock',`\ Q ') <br /> Municipal, ❑ l <br /> WELL LOCATION SKETCH Other ❑ 1 - <br /> 5) EQUIPMENT (6) GRAVEL`,SCK `� 4 <br /> Rotary ] Reverse ❑ Yetis a No ❑" Size \ - - <br /> ahkr ❑ Air ❑ I7gaisi#:ter of bore r <br /> then ® Bucket ❑ Paclrrd fsnm tow —ft <br /> (7) CASING INSTALLED ` (8) PERFORATIONS. - <br /> Steel ❑ Plastic ❑ Concrete ❑ Type of perfafuttun or sire of screen <br /> From To Dia Gage..ar From' ` To `,Slot - R <br /> ft ft m Wall ft fts ze - <br /> (9) WELL SEAL <br /> I <br /> Was surface sanitary Beal provided? Yes$1 ho ❑ If yes to depth—L4-6--ft = - <br /> W ere strata sealed a, Inst pollution' Yes ❑ No ❑ Interval��t <br /> Method of seaLn <br /> e m e n t G r o u t Work start - 19 Complet 19 <br /> (10} WATER LEVE WELL DRI ER S STATEMENT ;�$Z <br /> Depth of first Nater if known ft Thea well war 11 r m Ticrisdcction and this repcert is trice to the ben o) n <br /> Standing level after well completio <br /> ft knowledge a be el } <br /> (11) WELL TESTS SIGNED (Well Duller)T <br /> 1Nas well test made:' Yes ❑ No Z If yes by whom' Air lift _(��mitt o n d Cor Drilling Inc <br /> C <br /> Type of [est Pump ❑ Bailer © ❑ j'tyA9vl'1:,•• - <br /> (Person firm or corporation) (Typed or printed) <br /> pth to Nater at start of test—ft At end of test -ft 10556 P 2 t U n i a L N <br /> �iours Water temperature Address <br /> arge��al/min after., Palo C e d r o C A Zip 4- 13-89 <br /> cal analyses made? Yes ❑ No <br /> If yes, by Nbom? City <br /> W as electric log made? Yes 9) No ❑ if i es attach copy to this report License No <br /> mate of this repur* <br /> MBERED FORM <br /> DWR 188 IREV 7 lei IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NU <br />