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LIGINAL STATE OF CALIFORNIA Do not fill to THE RESOURCES AGENCY III with DWR DEPARTMENT OF WATER RESOURCES NO. 216166 of Intent No WATER WELL. DRILLERS REPORT State Well No �y rmtt No or Date Other Well N._46 I/ 0 ��uwell-1-4-11-0well-1-4-11-0— OWNER ttNam M c C o rm 7p k t Baxter (12) WELL LOG Total depth 14 3 ft Depth of completewell-1-4-11-0ddres r U Box 1 7 2 O from ft to ft Formation (Describe by color, character size or matenal) Stockton . CA z,p95201 0- 32 Dark Brolla Dense C1 ) LOCATION OF WELL (See instructions) 32- 75 B I u e C iiunty_ San J o a q u] n Owners Well Number - 75- 90 Sandv C 1 av Nell address if different from above S Slockton & C 90- 14 0 Coarse S - Some Clay L hip 11 N RFect ange s .. - ce fmm cities roads railroads,fences,etc (3) TYPE OF WORK ; ' New Well]S] Deepening ❑Reconstruction ❑ Reconditioning ❑ - l Horizontal bell ❑ Destruction ❑ (Describe destruction materials and, /y procedures in Item 12a; ! �i (4) PROPOSED USS 1 - `\ �� /�o See Map Attached Domestic 1� - _ ` ` r Irrigation � �' � ❑ �" �` Industrial `�ti \ ❑ i - / Test Well �� / ❑ Stuck\`\ ❑, Municipal, ❑ WELL LOCATION SKETCH � Qther MW EQUIPMENT (6) GRAVEL\ ,,ACK Wary K) Reverse ❑ Yes 41 No ❑I Size - - Cable ❑ Air ❑ Dla?u�e{of bore 10 5/8 \v her ❑ Bucket ❑ Pai Jird frem 12 3to„ 14.3_ —ft CASING INSTALLED (8) PERFORATIONS, � - steel ❑ Plastic ® Concrete M Type of perfofetlan or stere of screen -From ToVIa Gage or Fr .'To Slot _ ft ft m Wall ft. , ft - VC 0 140 4 5 c h40 - (9) WELL SEAL[as surface sanitary seal provided? les)m No ❑ If yes, to depth 3 ft ere strata scaled against pollutions Yes ❑ No ❑ Interval_ fr - - _ ethod n! seahn• Work start 19 Complet l9 (10) WATER LEVELS WELL DRILL R'S STATEMENT epth of-first .cater, if known H This well war dri ed r my tui diction and this report is true to the best at my undine level after well compleno ft knowledge an Iic 11) WELL TESTS SICK D Was well test madeP Yes ❑ No ® If )es, by whom? 11 a Duller) Upp, of test Pump ❑ Bailer ❑ Air )ik Q NAME 0th to water at start of test.Y..___—_ft At end of test --ft (Person £inn, or corporation) (Ty or printed) cal/min hours Water temperature Address 10556 P e t u n l L N after cit Pal o Cedr6 CA _7A 6073 Lail anal)sss made? Yes ❑ No ® If yes by -horn" 512406 ate of than report 4- 19-89 _ rw_,�*m-iea ltric ]ng made? Yes [] Ao p4 If )es attach copy to this report License Na !REV 7 76) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM i