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ORIGINAL STATE OF CALIFORNIA Do not fill in <br /> File with DWR <br /> THE RESOURCES AGENCY n' <br /> DEPARTMENT OF WATER RESOURCES NO. 150824 <br /> 01 Intent No WATER WELL DRILLERS REPORT <br /> d ��02 State Well Vu <br /> nnn <br /> 1 PElt No or Date85 -1029 Other W ell N,00 L.f 77 -7.-, <br /> ( I ) OWNERvarve (12) WELL LOG )�ff.,��� <br /> Tot rl depth..�5tt Depth of completed well 460+t <br /> .admss. Gua AVE . <br /> 101,.10 al from ft to ft Fomiition (Describe by color charicter size or matenll) <br /> (-rt, Gilroy, Calif. Z,p950 0 0 2n - CIPY - <br /> _') LOCATION OF WELL (See tnstruf-bons) L360 Glay <br /> C«imh Owner, Well Number 6L--: Sq 12 <br /> y <br /> LLS _,_,_ <br /> 1�ell iddress if different from ibove rson Pass R V Clay <br /> T+«nshrp-.Tr.D-C7l _Range Sect.o 373 78 Sand <br /> Di,tin a From cities roads rlilmids Fences etc 37 - 380 Clay _ <br /> 39' 395 Lcinnd <br /> (3) TYPEOF WORK <br /> New Well X Deepening ❑ <br /> Reconstruction 02 r <br /> Recondtlioning (] - Sand -' <br /> Horizontal Well ❑ _ 0 Q <br /> ray <br /> 1{ <br /> Destruction ❑ (Describe 0 - 455 Sand <br /> destmetion materials and �� <br /> procedu-es in Item 12) = _ <br /> (4) PROPOSED USE <br />! Domestic X <br /> I Irneahon f1 _ <br /> IIndustrial ❑ _ - <br /> Test Nell tQ _ <br /> Stock ❑ _ <br /> Municipal Q - <br /> WELL LOCATION SKETCH Other [j - <br /> I EQUIPMENT (8) GRAVEL PACK <br /> atlas reverse ® Ye7Z3 No ❑ Sized - <br /> Cable [] Air ❑ Diameter of bore _ <br /> Other p Bucket ❑ Packed <br />(7r CASING INSTALLED (8) PERFORATIONS - - <br /> Steel ❑ Plastic j Concrete Ck Type of perforation or size of screen <br /> From To,-- Dia Gage or From To Slot - <br /> ft ft 'In Wail ft v ft �;s ze _ <br />(s) WELL SEAL <br /> Was surface sanitary seal provided' Yes ❑ No ❑ If yes to depth ft <br />"ere <br /> - <br />"ere strata sealed lgainst pnilution9 Yes ❑ No ❑ lnten%l „ „ft _ <br /> Method of seahne_- __ - i Work started 19 Completed,-�_ <br />;10) WATER LEVELS WELL DRILLERS ST3TEME.N4T <br /> Depth of first water if knownft This well tear drilled under my rumdretion and this report is true to the bent of my <br /> sanding level after well completion ft knotiJedge and belief <br />`11) WELL TESTS <br /> Vas well test mlde? Yes ❑ No ❑ If yes by whom + (We Driller) <br /> Type of dost Pump ❑ B'eiler ❑ Air lift ❑ N 141E - r a l wa.t EOZ_ h" I,11,Z1 G' y <br /> ��- -� <br /> Depth to wlter a start of test ft At end sof test ft ']("(&rs5•finX: rjrfty=on) ( peel or pr t ) <br /> e gal/min after hours �V1ter temperature Address J r 111 <br /> Turlock Ca p. 953$0 <br /> 1I lnilysis mode' Yrs ❑ No Q If yes by µhnmI City 1� Zi <br /> AS electric log In1dc' Yes ❑ Vo Q If les lttLch cops to this report License No 'f 1 Date of this repo <br /> 7`/VR 188 (Rt.V 7la) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />