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i <br /> r:astomer obtained permit <br /> ORIGINAL STATE OF CALIFOftNIA Do not fIl to <br /> THE RESOURCES AGENCY 1 <br /> No. J � � I O <br /> File with DWR DEPARTMENT OF WATER RESOURCES 1 <br /> of Intent No WATER WELL DRILLERS REPORT <br /> State well No <br /> 6 � :7I <br /> Permit No or Date - Other Well No �40��� <br /> ' (1) OWNER j,, Tr�toormGn"s ` ater Systems (22) WELL LOG Total depth-=ft Depth of completed well 1 TSS ft <br /> Address2120 !Yi off{. Rd• from It. to ft Formation (Describe by color character size or material) <br /> City _Stockton Calif. Zi 20 - A A <br /> aks- <br /> ' (2) LOCan ATIQN OF WELL (See instructions) Q <br /> County o U1n Owners Well Number - 103 M ay <br /> Well address if different from above 2 01 Learned 103 107 Sand <br /> Township n Range ection. 107 = 130 Clay <br /> Distance from cities, roads railroads,fences,etc 130 Q7 Sand fine <br /> ' - San169 claz _ <br /> (3) TYPE OF WORK <br /> ' New Well 7L Deepening ❑ Y y <br /> Reconstruction ❑ <br /> Reconditioning ❑ - <br /> Horizontal Well ❑ - <br /> ' Destruction ❑ (Descrtbe = <br /> destruction materials and <br /> .procedures in Item I2) <br /> (4) PROPOSED USE - <br /> ' Domestic Priv. <br /> Irrigation ❑ <br /> Industrial ❑ - <br /> Test Well ❑ - <br /> Stock 0 - <br /> Municipal ❑ - <br /> WELL LOCATION SKETCH Other ❑ <br /> (5) EQUIPMENT (8) GRAVEL. PACK - - <br /> Rotary &N Reverse ❑ Yes d[ No ❑ Sue - <br /> Cable ❑ Air ❑ Diameter of bore to _ <br /> ' Other ❑ Bucket ❑ Packed from .50 <br /> (7) CASING INSTALLED (8) PERFORATIONS <br /> Steel ❑ Plastic Concrete ❑ Type of perforation or size of screen <br /> ' From To Dta Gage or From To Slot <br /> ft ft. in Wall ft ft size <br /> z5 10 1 - <br /> ' PSI <br /> (9) WELL SEAL n <br /> Was surface sanitary seal provided' Yes.Mil No ❑ If yes to depth 5�,r-ft <br /> Were strata sealed against pallution? Yes ❑ No ❑ IntervaL ft <br /> Method of seaLmg Bentamtp Work started 19 Completed -,J <br /> - 9 <br /> (10) WATER LEVELS WELL DRILLERS STATEMENT <br /> Depth of first water if known Thu well was drilled under my lurudfettan and Pis report is true to the best o/ my <br /> Standing level after well completio ft knowledge and belie/ <br /> (11) WELL TESTS SIGNED <br /> Was well test made'd Yes ❑ No ❑ If yes, by whom? (Well Drier) <br /> Type of test Pump ❑ Bailer ❑ Air lift 0 NAME Calwater Drilling Go,—Inc- <br /> Depth <br /> to water at start of test It At end of test # (Person, firm, or corporation) (7-yped or printed) <br /> 0'electric <br /> gal/min after_ hours Water temperatureAddress300 r/ _ <br /> ! Trny <br /> analysis made;' Yes ❑ No ❑ If yes, by whom? City Turlock,ZT Ca_�__Lf- 7A-0 <br /> a. electric log made Yes C3 No C1 If%es attach copy to this report License No 43421$ Date of this repo <br /> DWR 188 (REV 7-76i IF ADDITIONAL SPACE 15 NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />