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LIGINAL STATE OF CALIFORNIA Do not fiU sn <br /> THE RESOURCES AGENCY <br /> He with DWR DEPARTMENT OF WATER RESOURCES No. 216169 <br /> Intent No WATER WELL DRILLERS REPORT State Well No <br /> rnut No or Date Other Well No(1 �D - <br />�) OWNER Name McCormi ck & B (12) WELL LOG Total depth-19 7 Gt Depth of completed w 1eIL�t <br /> sires Box 1728from ft to ft Formation (Describe by color, character size or matenal) <br /> ityStorkton . CA Z113 95201 Q- 30 nark Rrnwn Cla� <br /> I) LOCATION OF WELL (See instructions) - rppn C1 l - <br /> mt, San Joaquin Owner s Well Number lens <br /> Vell address if different from above S . tockton & Church 6 100 B 1 r e s e n S e clay <br /> 1hipwna - 11 N -- Range, 6 E ,.,,_Sectio 100- 135 Blue B e e n <br /> stance from cities roads railmads fences, etc 135-159 S a n <br /> B <br /> 70- <br /> (3) TYPE OF WORK 1 7 9 - 7 $ <br /> New Well In Deepening ❑ _ <br /> Reconstruction Q <br /> Reconditioning ❑ �\ <br /> Honzontal Well ❑ - �� \� <br />' Destruction ❑ (Descnbe - <br /> destruction materials <br /> procedures in Item 1 an< �\ <br /> (4) PROPOSED US - C\ <br /> See Map Attached Domestic TV- <br /> IIrri},anon �`� `\�� ❑ <br /> Industrial \�\ j ❑ <br /> Tesf�}Vel] ❑ 71 <br /> Stack`\�\ \l <br /> i <br /> Municipal\! ❑ - <br /> WELL LOCATION SKETCH Other Mx- K1 <br /> EQUIPMENT (6) GRAVEL,"CK <br /> nary ® Reverse El �e(` No [J" 5j 3 t an(r <br /> able ❑ Air ❑ .Dsit`q�e(o(bore 1 O 5 `' 77 <br /> her ❑ Bucket ❑ - <br /> } CASING INSTALLED e ^ (8) FrERFORATION$s. <br /> steel ❑ P1a%UL (a ConLFVte ❑\ Type of perforation or size of screen ' <br /> 11 <br /> From To -Dia Gage or From` To Slot <br /> ft ft `in Wa11 ft \\ ft \slze - <br />'C 0 195 - <br /> 9) WELL SEAL - <br />"'as surface sanitary seal provided' Yes K) No ❑ If yes, to depth_1 7 9 h - <br /> em strata sealed a6arnst pollution? Yes ❑ No ❑ Interval ft - <br /> ethod of sealing Cement & Work started - 19 Coinplet - 19&9L-- <br />(10) WATER LEVELS WELL DRILL R'S STATEMENT 1gj <br /> epth of first water, if know_ - ft Thu well was dr d r my nadlCrion and this report is free to the hest of my <br /> tandmg level after well complellolL ft knowledge a eh <br /> 11) WELL TESTS SIGN>=n <br /> Was well test made Yes ❑ No [X If yes, by uhom� (Well Driller) <br /> Fp <br /> orf teat Pump ❑ Bailer ❑ Air lift ❑ NAME Di amond re Q r1 1 1 1 n I nh to water at start of test - -ft At end of test ft (Person, firm or corporation) (Typed or printed) <br /> rge _ cal/rrun after,, hours Nater temperature Address 10556 P t <br /> unia Ln <br /> anal'sis made? Yes ❑ No M If yes, by uhom2 Cit' R z1p 96Q�P.11 <br /> lectric loi. made2 Tes ❑ No IN 11 tes attach copy to thisreportLicense No 51r2406 Date of this report, 4- 19-8 9 <br /> 188 ditty i 76I IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUM13ERED FORM <br /> I <br />