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.k. (,P i -ON NO t UriLL r%i <br /> Fs <br /> Not a<!t In <br /> ORIGINAL WATER WELL DRILLERS REPORT NO Do NN 1U I2 <br /> File Original,`Duplicate and Triplicate with iiia (saetsoesa 7016,7011,7078,Water code) <br /> REGIONAL WA'T'ER POLLUTION State Well No <br /> CONTROL BOARD No 5 THE RESOURCES AGENCY OF CALIFORNIA �"LOtherwestNa_ �S <br /> (Iasrri ap)roprtale assbp) <br /> OWNER. (11) WELL LOG: <br /> ,Me QIP SandSTotal depth 100 it Depth of completed well 100 <br /> it <br /> Address Ht s,z" 2 BOX '%3B8 - _ Fnritsatwp Describe by color rberaeier size of moserisl,and strarsnre <br /> Ripon Calif, ft to (t <br /> and <br /> (2) LOCATION OF WELL 12, 15 s am and rocics <br /> county San Joquin Owners number if any— 16 24 sand <br /> R F D or Street No rown Cr <br /> lay <br /> 6110 _moi%e 1Tortn 99 H.'741 and e %d 4r San <br /> s >; of PTorth Hioon road 40 gray c ay <br /> N _ . ;fie. 19 T- 0--S R 8-- Es 48 ed clay <br /> 72 3 sonncoarse <br /> 80 9& crown clay <br /> (3) TYPE OF WORK (check)• 96 100 sari <br /> New well 6 Deepening 0 Reconditioning ❑ Abandon ❑ <br /> if abandonment,describe material and procedure in Item I I <br /> (4) PROPOSED USE (check)• (S) EQUIPMENT <br /> Domestic F Industrial [] Municipal Rotary El <br /> Irrigation ® Test Well [:] Other Cable 12 <br /> Dug Well <br /> (6) CASING INSTALLED: If gravel packed <br /> sINGLE 2g DOUBLE ❑ Ga e <br /> g Acamerer from to <br /> From it to it D,am <br /> or <br /> of Sore ft it <br /> r - -84 10 12-- <br /> Type and size of shoe or well ring $;� Saxe of gravel <br /> Describe joint Rj <br /> it <br /> (7) PERFORATIONS <br /> Type of Ftrforator used Fsjctory <br /> Q <br /> Size of perforations 8 in length by 1 to <br /> From it to ft Peri per row Rows per it <br /> D 64 <br /> (8) CONSTRUCTION <br /> Was a surface sanitary seal provided? ❑ Yes ❑ No To what depth ft <br /> Were any strata sealed against pollution? ❑ Yet ❑ No If yes note depth of straw �• <br /> From ft to it <br /> .T <br /> Method of Sewing — — Work started 5-4-,655 19 Completed — —O <br /> (9) WATER LEVELS. WELL DRILLERS STATEMENT <br /> r�rN1 it rhes well was drilled under my jurisdiction and this report u trite to the bent of <br /> Depth at which water was first found my knowledge and belief <br /> Standing lerri before perforating 2,,.,+ it <br /> NAME John Paazero 1c, and yarl 2cLeister <br /> andtng level after perforating ft — <br /> R � (�rw�OX r�yyo�t—q,� fryprl or prlirirl) <br /> Address s .1 `.��Ly� V <br /> WO) WELL TESTS: Stockton Calif <br /> Was a pump test made? ❑ Yes [) No If yes by whom' � �si _ <br /> [SIGNF.n] � <br /> Yield gal/min with it draw down after hrs GG pp ! Weil DrrBer <br /> Temperature of water Was a chemical analyse made? ❑ Yes ] No License No 21J� U9 Dpttr ._...—._s 19 _ <br /> r <br /> Was electric log made of well? ❑ Yet Cl No <br /> areas a as zeta Quin©A apo DWR 168 IpEV 3 341 <br />