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ORIGINAL STATE OF CALIFORNIA Do not fill zu <br /> File with DWR <br /> THE RESOURCES AGENCY <br /> DEPARTMENT OF WATER RESOURCES NO. 150868 <br /> °f I ntent No WATER WELL DRILLERS REPORT St ite Well Nn <br /> Prrmit No or Date V 2 6 A. r 1�a <br /> Other t1 elf V,, GJ,�,.J <br /> ( 1 ) OWNER v,n,E (I?.) WELL LOC <br /> Tot it dept}L5Q,Qft Depth of wmpleted well_. QFt <br /> farm ft to ft Forin ittnn (Describe by enlar ch tfacter size or m iterial) <br /> (it, racy 0 Ca IIf- zip 6 - <br /> (2) LOCATI ELL (Sc!e instructions) 2n 9,q nd <br /> C<nrnty talk Sl._ � net% Well Nuirnber - <br /> 1tiell iddre%s if different from above �j2 Clay Township _ Range Sectio 2 2li <br /> 20 la <br /> DrStanCe from cittei roads rulroads fence% etc 220 - ...225 Sand <br /> 22 - 2 Cla . <br /> 235 - 240 Sand <br /> 240 - 245, Cla <br /> (3) TYPE <br /> ��OF WORK 2 ;' 270 �S nd <br /> New Well)E Deepening © . 270 , -,V 0 Cla <br /> Reconstruction Q 5 5 Black sand <br /> Recondt'romng ❑ <br /> Horizontal W ell ❑ _ ""- <br /> Destruction [p (Describe 46 - 8o <br /> destnection materials and <br /> procedures en Item 12) 480 - 00 Clay <br /> I (4) PROPOSED USE- T <br /> Domestic YED <br /> i <br /> irrigation (J - <br /> 1 industrial ❑ - <br /> Test Well ❑ <br /> Stock 0 _ <br /> rvfunicrp ll ❑ - <br /> KELL LOC.&TION SKETCH Other Dairy I - <br />(5) EQLIP%IEhT (6) GRAVELPACK _ <br /> Rotary 'i Revere ❑ IesA] Nu ❑ Siz _ <br />'able ❑ Ayr ❑ Diameter of bore 121, <br /> Other ❑ Bucket ❑ Packed from-10—0to 480 ft - <br /> t71 CASPVG IVST4LLED (8) PERFORATIONS - <br /> ateel ❑ Plastid] Concrete❑% Type of perforation or size of screen -1 <br /> - <br /> Frorn To Dta Gages or Froia,", To Ski = - <br /> ft fel 1n Wall ft��� ft i /SZ - <br /> g) WELL SEAL <br /> Nas surfice sanitary seal provided' Yey❑ No ❑ If ves to depth_ICLO—ft - <br /> Were strata sealed against polluttona Yes ❑ No ❑ Interval ft _ <br /> lfethnd of seahn <br /> Work started 19 Cnmpfet ]9 <br /> 10) WATER LEVELS WELL DRILLERS STATEMENT <br />.)epth of first water if known - ft This well was drilled ander my pirisdteGrm and this report is bice to the best of incl <br /> Standing level .tftrr %ae1l completion it lnowled&e and belief <br /> 11) WELL TESTS SIC\ED <br /> V iS well teat m idea Yes ❑ tin ❑ If Nei by whom" (Well Driller) <br /> ype of test Pump ❑ Bailer ❑ air lift ❑ <br /> m NAME—depth to water it at <br /> of test Ft :\t end of test fi <br /> {Person him ur corporation) ( ped nr pn ted <br /> al/at,tn after hours W iter temperature Address <br /> tntivsts madeaa City Turlock. ra I -I zip�'� do <br /> Yes ❑ '�a © If ves by whom tY -•••-_ r-� <br /> V u electric fol, madca Yes C] No [] If%es attach copy to this report License No 43421-8 _- -Date of this repo <br /> SWR 199 1REV 7 76I IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />