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STATE OF CALIFORNIA Do Not Fill In <br />� ontotrt�u, THE RESOURCES AGENCY NO 63488 <br /> DEPARTMENT OF WATER RESOURCES <br /> File with DWR , <br /> WATER WELL DRILLERS REPORT State Well No r <br /> Other Well No r l r <br /> (1) OWNER (I 1) WELL LOG <br /> Nam <br /> S- Total dip E4 ft Depth of completed well ft <br /> Address <br /> Formatian Drs—he b)color cberarter sere a/material and structure <br /> ft to It <br /> (Z) {L+OCATION OF WELL <br /> Cnunty San Joa u?n Owner member .f anv <br /> Townsh,p Range and Seet,on <br /> w <br /> U,stance from cu,ea roads n,lroads etc <br /> A 13 el <br /> MAY <br /> (3) TYPE OF WORK (check) <br /> New Well X3 Deepening ❑ Reeondttsontn <br /> g [] Destroying ❑ 45-76 Clav <br /> If destructwn desa ribe tnatertal and procedure in Item II Sand <br /> (4) PROPOSED USE (check) (S) EQUIPMENT. <br /> Domestic X] Industrial ❑ Municipal ❑ Rotary lid 86-88 Cl ay <br /> Irrigation ❑ 'Test Well ❑ Other ❑ Cable ❑ <br /> 88-105 r,-rajZP-1 <br /> Other ❑ <br /> (6) CASING INSTALLED _ <br /> 1 i n Clay <br /> STEELX OTHER If gravel packed <br /> SINGLE :K DOUBLE ❑ <br /> Gage Diameter 1 123-135 Cl ay <br /> Prom 1 u or of From To <br /> fr tr Diam Wall Bore ft 1 ft Sand—& ar-RA.Fel 8, Clay <br /> 10 n J`71 <br /> pea <br /> �,ze ut,hue� w<fl rrnR <br /> welded� Size or rravrt <br /> Ue ribr,u,n[r <br /> (7) PERFORATIONS OR SCREEN <br /> Tvpe of ocrsun can ar name of seretn <br /> Perf Rows <br /> From To per per Size <br /> ft ft row ft in -tin <br /> 154 174 x t: <br /> (S) CONSTRUCTION woler Co&e c 13/52 <br /> Wa : url ate san,ta ry seal prov,deda Yes No ❑ To what depth 50 fE <br /> W rrr sur tut,islet srs,nat pailur,ona Yes ❑ bio❑ I1 Yes naredepth otstrata <br /> Fwm fE <br /> to ft <br /> fs s� .7 r� <br /> From to ft Work staeted l9 (2 �'rGCo,npleted 9 7 19 G <br /> %lnhod of.t2bnRper) W£LL DRILLERS STATEMENT <br /> (9) WATER LEVELS- Tries well was Jelled under my jurisdiction and this report to true to t&t b,at <br /> of <br /> Uepth at wh,ch weer was fiat fount ,f kpawrt it m5 knotaledge and behrf <br /> NE4-1—i 'crcl bcfure parforaung ,f known it NANmHenninnS BrOS o Well Drilling Co. Jrc <br /> ]sas,J,nti <br /> 1-1 artcr pertorarrng and desreroprng ft (Perwn firm or eorporat,on <br /> ) (Typed or perused) <br /> 10) WELL TESTS Addres, 2500 We Rumble Rd. <br /> =apwmp rc c naJe7 Yes i10 If vn by..hom} MOdest0 Caljf. <br /> ^>! Ral Jm tth fr drawdown aims his LSIGNED] s <br /> Temperature w water Was a ehemrcal analysis madea Yes V No { .t L +� !Weft Drr 1 <br /> el ` <br /> W.. eetne I.R madeof wells Yes Q N If yes Bruch copy LkCet]se I�fO k 1 632G,Y,,,, Dyfed 7 Q�r(� r =y--72 <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br />