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TRIPLICATE STATE OF CALIFORNIA DU not fill <br /> Owner's Copy THE RESOURCES AGENCY p� Q <br /> DEPARTMENT OF WATER RESOURCES N0. 072877 <br /> r.o nr Inlent Nn.—__--___-- WATER WELL DRILLERS REPORT State .— <br /> al 1'rnuit No. nr 1)an•_'—'---- Other <br /> 11 ) UW'N1ai: ........ _- OXY CNS (12) WELL LOC: Taad di,rin�Q_it. De,61 aran,rr,delyd w:•it <br /> \ddn•,s_ _ _- frum ft. to it. (Dor mbe by u+hr, chat."tel, stir err ur.rlerial1 <br /> ( __LATHROP CALIF ,,, 0 - 2 sand <br /> (• (see instnl(aiutls <br /> 2 - $ c1@ <br /> ?j L (+• 'I N � 'ELL tie sand <br /> (:,,uid,•_�n �'oAruz _Ovvnris Wrll Number IW2 - �j <br /> K'cll.uldress d dillera•ul from ab,+ve 64 - 75 clay <br /> ........ _ �_ liarrtle 6ESeetint. 35 7502 sa n <br /> I A,t:ar,c Irum cities. roads, milr-ids, fenves,elc. 102 7126--CZa <br /> 2 - 156 san <br /> C1Ay <br /> (3) TYPE OF WORD: pqR <br /> -3II1 Clay <br /> Nese Well 4' Ih•rpenitr8 ❑ <br /> lircnnslnrtti'O1 ❑ 320 - n cl&Y <br /> licavuditionini; Q - <br /> 382 sandi <br /> Itnritantal \'ell ❑ - clay <br /> 1)a•structran c• (Describe 406 -432 Band <br /> destnmtian urateriels and <br /> p `' <br /> m 4 <br /> nKedurs in Ite12) - 466 clay <br /> (4) PROPOSED USE: 466 - 494 sand <br /> 1)mlrratttQ 494 - 510 clay <br /> Irriv.itinn ❑ - <br /> I Indusln:d ❑ - <br /> i <br /> 'fest W,P ❑ - <br /> Sarelt c <br /> j Alanicilml p I - <br /> \\'ELL LOCATION SKETCit Other <br /> (.l) EQUIPMENT: (A) GRAVEL PACK: - <br /> liot:rn ❑ lirversr ❑ Yro ❑ Nn ❑ Si, <br /> C.dde ❑ Air xJ Ui:mieter of h.+rr_ <br /> (W.- ❑ Huckrt ❑ Pwlkral loon _d, 4. - <br /> 17) CASING INSTALLED: (8) PERFORATIONS; - <br /> strel [x I+laatic Q C,rn rate ❑ T,pr o! perfnratioo nr site of scrim - <br /> F nrill To Dia. Cage or From To Slot - <br /> ft. ft. ill, Wall ft. ft. size - + <br /> 0 510--..8 7 00 20 super to - <br /> 02 - I <br /> 4M � - <br /> (J) WELL SEAL: 9 Was surfaco .smiitar) sell pnrvidtd? Yrs ot No, Q If yrs, to depth tt. - <br /> W,-ry str.,ta sc:ded aCaiust p„llution:' Yes ❑ 10 ❑ Inten'al !t. - <br /> 11,lhnd .,I svalinl' \t'ar1, starn•d_____ —IJ____ (]nnplrlcd _. 14_._ <br /> (lo) WATER LEVELS: WELL DRILLERS STAITMEN'T: <br /> 1).•pth If lint sv.urr, it 1.uown ft. This ua•N ei•ru drilled "oder Pity lurmlimmit and this relmrr is tna• ra tht best of r. <br /> 11.rwbni: Irvel .rlta•r ,ell ruurpleliun !t. kru+u lr•dgr .nrd belrtf. <br /> i 11) WELL TENS: Sju,,u) <br /> I'll test made? Y- ❑ No ❑ II Nes, b) ahoru? (Well Driller) <br /> If test Pump •` Bader ❑ Air lift ❑ EAmn�t �_ T11/�� - <br /> N.q\tE_ � 11\L4 <br /> 1 Depth to scaler at suit .I lest rt. At cud or test it I l'en,m, It ru+. ..r.to pnr:dnul) (I}'pad ur pTinted) <br /> srhar r Addm,s p 0 BOX 0 5 <br /> 8 ;:al/min after- hours Water trnyx:rahue —�— <br /> �emical analysis made•? Yes Q No ❑ If yrs, by whtml? City WOODIA Y)-- Zt <br /> �i',u rla•ctric Int! mmlr? Yes ❑ Nn (, If yes, attach cagy to, this rerw rt License No. A3C57 Date of this rel—t <br /> DWR tee tREV.7.701 IF ADDITIONAL SPACE 1S NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />