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IRIGINAL STATE OF CALIFORNIA Do not fiU in THE RESOURCES AGENCY File with DWR DEPARTMENT OF WATER RESOURCES No. 216165 6-7 — L t No WATER WELL DRILLERS REPORT State Well Noo or Date Other WelI NoOWNER Name M C rmick & Baxter (12) WE"LI. LMi, 'Total depthl 94^ft Depth of completed well . 9ss P 0 1 7 2 8 from ft- to ft Formation (Describe by color character rite or Material) city Stacktnr CA Zip 95201 Q -32 Q a r k Brown dgn5g Clayy LLO ATION OF WELL (See lnstmebons) , an Joaquin Owner's Well Number - C A ell address if different from above & C h u r C h 90 -145 Sand eau o m e Clay t m m nship 1 1 N. . ,—Range 6 E �Sechm 145 -183 C Dark s e- Blue tance fricities ads railroads fetiecn etc S 'r a V e l - Clay (3) TYPE OF WORK New Well Q9 Deepening ❑ ' Reconstruction ❑ - Reconditiomn6 ❑ C� Horizontal Well ❑ - n Destruction ❑ (Describe destruction matenals art procedures in Item (4) PROPOSED USF - A "n ' See Map Attached Domestic ON Irngation \ ❑ lndustnal �t \` ❑ �r �' 77, Tes�Wel! �✓ ❑ 77 1 r,N Stock �\ R \o 77 '! IV WELL LOCATION SKETCH Qther w P9 - , EQUIPMENT (B) GAAVEL\PACY star) 13 Reverse ❑ 1}et No ❑ Site r\� �7 able ❑ Air ❑ of bore 10 518 p her 13Buckct ❑ P�lac\k\e� from 17`t tci\ 1 `t __ft CASING INSTALLED � (8) PERFORATION�I, - )tee! ❑ Plastic ® Concrete C}` Type of perfosa(icin or size of screen t - F rota To - Dia cage-0; Frou>,, To of ft ft in Wall ft ft `size - J C 0 192 4'" 5 h 0 182 19 - (9) WELL SEAL - 1%as surface sanitary seal provided? Yes ® No ❑ If )es to depth 174 ft JeZ:trataiieseal.ed a ainst polluhon� Yes ❑ No © Interval,of ahne m e n t Grout Work start - l9 Complet - 1 (10) WATER LEVELS WELL DRIL ER S STATEMENT 35�, epth of hist Nater, d known -- --- ----fr This well t ndertmv ?i diction and this report is trio[ to the best of mif anding level after well completio ft l r+owledee a 2i 1) WELL TESTS SKIED N'as Nell test made" Yes ❑ No K) If yes by whom' (Well roller) 1pe of tent Pump ❑ Bailer ❑ Air lift ❑ NAME epth to Niter at start of test ft At end of test_ ft (Person firm .'corporation) (Typed or printed) arge gal/ricin after________hours Water temperature Address 10556 Petunia/ L N 1 analysis made I es Q No [X If yes, by whom City Pal o Ce d r o C A Zip 9 Fl n7 '4 IW-k-R],_88 tnc lov made" Yes ❑ No XD if yes attach cop) to this report License No 51 2 4Q6 -nate of this report 4- 19-89(REY 7 76) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM