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ORIGINAL STATE OF CALIFORNIA DO not fill to <br /> File with DWR THE RESOURCES AGENCY <br /> DEPARTMENT OF WATER RESOURCES NO 060006 <br /> ,if Intent No 148144 WATER WELL DRILLERS REPORT <br /> ',rout No. or D1te Stite Mell \o <br /> Other It ell lin S �-�� +�-5 <br /> ( 1 ) OWNER ti tine (12) WELL LOG <br /> 22317 So. Corrol Hollow Tottl cle,,h _tt Depth of completed well_ft <br /> Atldre�, trout ft to <br /> rt Fomtlhon (Descrnct bi color chtotter Brie or material) <br /> rt. Trac Ca 17 f. ,tp _ <br /> (2) LOC�TIO� OF WELL (see utNttactlons) <br /> Crrrrnh_ an oaqui n .,..`Otsners l4eil Number - '' <br /> 1�ell uldrew if drfkreut front ibuve, Pattprsoi Pass Rd - <br /> Township R1nge _ <br /> 2S— -gand <br /> Sectio tan n ��TCL1V <br /> Dntcnce F170111F170111Citieses mads rtilmads fences etc fF / _ <br /> 48 rock <br /> 5 la <br /> 7 - 59 ' sand and gravel <br /> 59 - 69 ra clay <br /> (a) TYPE OF WORK �9 ,-� 70 sand and ravel <br /> \ew 11e11 x Deepening ❑ 70/ 5 ra Ca and rock <br /> Rer.onsrructian ❑ 85 - 9 , Drowtn_ clay <br /> g� Recondituminl, ❑ �� 97 - 105 sand, an+.] ravel <br /> Honinntll NI ell ❑ 1��105 - 119 rav Ca <br /> Destruction = {Describe t `,f 1 - 120 sma l grave 1` <br /> 7' ' <br /> destruction materials andprrrcedures m Item 12)` F2 - 13 Qray e ay an roC(4) PROPOSEDUSE- 1 -a stric o ari ' an grave1�, Domestic & - _ rolNn an gray c ay an roc <br /> _, Irrry,atu,ri ❑ iot - 197 sandy Stone and grave <br /> ^f Indu4tn110 - 14:1 C ay_,s <br /> • 1� Test well ' ❑ _ san 5 011e an roc:Sti(k ❑ = gray clay an o <br /> CK <br /> Municipal ❑ an s tri Ick <br /> s <br /> ��ELL LOC#TION SKETCH Other _ ❑ _ Q roC <br /> r. <br /> tS) EQLIP%fE\T (6) GRAVEL, PACK251 - 259 blue shale <br /> Npt1n `� I'evene 0 'fes X3 \o ❑ Size 4 ^ -259-, 285 brown and tan clay <br /> C thle L� Air ❑ Diameter of bore 14 _= 285 293. blue clay <br /> Other ❑ $ricket ❑ Pteked From _ tpIt _ - <br /> r7y CASI\G I\STkLLED * {$I'PERFORATIONS shalp <br /> 300 _ <br /> Strel t/ strick,5 of b1.Ijg shale and snap <br /> ❑ Plastic d( Concrete•❑, T%pe of perfezahon or,yize of screen%1♦ - Stone and tan clay <br /> From TO/— Dia Car Fro ` <br /> To Slo ;� <br /> ft ft � rn Wail IF ft � s z _ <br /> C 1 x <br /> 9) WELL, SEAL <br /> 1t i5 surflce slnttary sell provcded7 les No �, If yes to depth.��.•.,_`ff _ <br /> V%I strlta celled i r-unsY <br /> 6 pollution Yes Vo-Z Inters ti [I—410 ft _ <br /> titethod of sealtn <br /> l�rtrk sorted IJ Cnmplet <br /> 10) WATER LEVELS WELL DRILLERS STaTEMENT <br /> Jepth of firtit water if knna Et <br /> 7hrr u.eff ucr dnlfrd unrlcr no uresdre rn rend thr port r true to the best of nrr) <br />+ttnclrnt; level after wel] completion ft Anou,fedc;e and F rrf <br /> c <br /> 11) WELL TESTS Stc\eD " <br />`vt, 5,fltc,tst made lei X \o ❑ If yeti by whom (Well r er) <br /> Pump ❑ Btiler ❑ air lift `-kME Canada Pump Sales d Service <br />)tpth to tv iter it st in of test—L4-0-11 At end nt 4yt ft Per�un firm or co orltion <br />>isc�f:11/titin tfier hours IV1ter tempt rahtre <br /> Address- <br /> P.0 ox 990 m (Typed or printed) <br /> antlysry m1de� Yer 0 \n Al If ye.e by whom? �:--1City Antioch, zip94509 <br />} lt.ctnt log :n <br /> D tde� yes ❑ \o , !f ger tttach co hr stirs re tort 78 ^` <br /> p F License \o342873 Ite of this report 9 <br />,WR 188 'REV 7 75) 1F ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />