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STATE OF CALIFORNIA Do Not Fill In <br /> THE RESOURCES AGENCY M NO 95284 <br /> ORIGINAL DEPARTMENT OF WATER RESOURCES <br /> Fila with DWR <br /> WATER WELL DRILLERS REPORT Stare Well No l rj <br /> ,-I- f"Other Well N6r�/ <br /> I <br /> OWNER (I 1) WELL LOG <br /> Name Tota]depth 17-2 ft Depth of compkrted wc]] 172 <br /> it <br /> Address Forme on Dr.rrrhr Fs rotor rbeurrrr r.zr of mefrr,ai eR!,sial-rr <br /> ft to fr <br /> (2) LOCATION OF WELL <br /> Lourie s• San joraquin Orntr,s number .f ant <br /> T--hw R—pt and Stenon <br /> 20 Clay- <br /> D'.L..Ce fr.m dots ra,d. —I—d, etc East, <br /> (3) TYPE OF WORK (check) <br /> New Nell13 Deepening ❑ Reconditioning ❑ Destroying ❑ 84 PA mcks <br /> //desirurtson,describe material and procedure sn Urns I! <br /> (4) PROPOSED USE (check) (5) EQUIPMENT <br /> Domestic ® Industrial ❑ Municipal ❑ Rotary ❑ <br /> Irrigation ❑ Test Well ❑ Other ❑ Cable FC] <br /> Other ❑ <br /> (6) CASING INSTALLED 17P _ <br /> STEEL OTHER If gray el packed <br /> SiNGLgC DOUBLE 1_.1 <br /> Gage Diameter <br /> From I u or of From To <br /> It It Dram Wall Bore It ft <br /> 0 15P 8 IP <br /> 12 12- <br /> y.xr of shoe r,r rill rink I <br /> Ur.cnbr..,intBut t3f a,d <br /> (7) PERFORATIONS OR SCREEN FF <br /> T1pr of Ottl.,r,unn or name of,creta i DPNIT? <br /> Perf Rows , <br /> J/r <br /> From To per per Size <br /> ft it rok it in z 1n <br /> 1 <br /> (8) CONSTRUCTION r <br /> tl�s a,.elate.,nitan seal pro,,drd> 7 es X N. Cl To ha.depth 2 f. <br /> r c ant sir,t/srs4C :rsr po'L.t,o�; '1rs ❑ NOD If tis rote dr-th pf.t a <br /> Frum fs to {t <br /> 1-rom it !: V orA .t,rud 19 Completed .9mP4 ]9 <br /> Nrthod„s .ral,na 73- - <br /> cementing vv ELL DRILLERS STATEMENT <br /> (9) WATER LEVELS Tbrs well was drilled under nr, Iurudichoss and that rrpo;t is rrur it; ibr brst <br /> l)epch at vh.ch r,trr .as fiat found ,f Ann..n fc o�m� knutt+ledAr and brl,rl <br /> s.and,nc lcsrl b,f-t prrfnr,—& ,f Annrn fc A),9F <br /> 5.an4,np level af.rr prrfaratrnp and deselapmti ft {I enon hrm or corporation} {T}prd rr pr,rrsrdl <br /> (10) WELL TESTS Address 11 - Ar, q- Van Allen <br /> "tai pump use madr7 )n D Nu 0 ]f via by rham; <br /> R,] 1— with fr drawdnwn,f,et hn [SIOACDI <br /> Tc tr.rr of rater NY.,,chem.cal,nail..made; )r. D No ❑ �] <br /> W.,ritctr.r lop—dr of wetly l ra ho If ie, aturh co t ��'a�} _ D1tcd 10-17- -- . ]9—}-3 <br /> CJ � pr License 1�D <br /> SKETCH LOCATION OF WELL ON REVERSE SIDE <br /> DWR 1813 iRcv 9rb, 251999 bo 9 eo tor+TRIP Qe osr <br /> �f <br />