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ORIGINAL STATE OF CALIFORNSA Do not fill in <br /> THE RESOURCES AGENCY n� <br /> File with DWR DEPARTMENT OF WATER RESOURCES NO. 150824 <br /> ntent No 'WATER WELL DRILLERS REPORT stite Well Vo _ <br /> 0",:q No or Date$ —102 Other Hell VnQ7-S0!4)C— <br /> ( 1 ) OWNER , (L) WELL LOG Tot it depth--14-5-.5-it l 460, <br /> J P It Depth of urntpletcd wel <br /> ludress, 104x.{.0 Gut al Ave . from ft to ft Form itinn (Descrthe by color character size or matenal) <br /> CaN Gllro Calif. z,p950 0 - <br /> (_') LOC AMON OF WELL (See tnstructtom) <br /> Owner, Well lumber - 1) Sand <br /> 11 ell ,ddrecrsif different from above ruc''on Pass` R . 1 - Clay <br /> 7a <br /> "'—nshl t re` ry —RanS,e Sect[n ]373 378 Sand <br /> D'11`103 <br /> im <br /> Di, a fnettles roads railroads rerces etc / - 0 [r'la <br /> (3) TYPE OF WORK395 r <br /> NewV,'ell Deepening ❑ 418 6 la y <br /> - <br /> Reconstruction ❑ 'z - <br /> Recondtliomnb fl435 - Sand" <br /> Horizontal Well ❑ = 0 C 1 <br /> ay <br /> Destruction 0 (Describe 0 Sand <br /> destruction materials and <br /> pror F <br /> procedures in Item 12) 7 7 - - J] <br /> i (4) PROPOSED USE - <br /> Domestic _ .1 _ - <br /> I _ <br /> Irrieation - = <br /> Industrial ❑ <br /> . Test Well <br /> Stock ❑ _ - <br /> E 'Municipal 0 - <br /> 14 ELL LOCATION SKETCH Other 0 <br /> >> EQVIPMENT (6) GRAVEL PACK - <br /> at", � `ieverse {] -zeyID No :3D ^�Size�jnl7` - <br /> v1 <br /> Cabe p Air ❑ Diameter of bore - <br /> Other 0 Bucket ❑ Packed from to £t - <br /> 1 <br /> (7 a CASING INSTALLED (8) PERFORATIONS f <br /> Steel Plastic 5 Concrete a Type of perforation or size of screen - - - <br /> Froin To Dia Gage or Fromi To Slot - <br /> ft ft , in Wall ftft - <br /> o 60\'77 - - <br />(9) WELL SEAL <br /> Was surface sanitary seal pmvideV Yes ❑ No ❑ if ves to depth ft <br /> Were strata sealed against pnlllition? Yes 0 No ❑ Intenal Ft - { <br /> Method of seabn Work started.. - 19 Comple[ — 19 <br />(10) WATER LEVELS WELL DRILLERS STkTENfENT <br /> Depth of first water if know ft <br /> This tt.e!l uas dolled untftr my t:i risdtciton and this report it tree to the belt of my <br /> Standing level iBer well completion It knowledgeanand <br /> belief i <br />{II) WELL TESTS SIGH-D <br /> Was well test made" Yes ❑ No ❑ If yes by whom" %1v elf Driller) <br /> Type 'if test Ptinip 0 Bailer G air lift Q <br /> �,AMIE Calwater Dry 1 7 ,_nlT Op_, _ � <br /> Depth to water it start of test ft At end 4 test ft rR rs fi r e ion) L ped Dr r t S <br /> 3 dV'e �. "�3��3� —� PT„.--rte <br /> t'-- -al/min f[er, hours Water temperature Address <br /> 0anTurlock C 9 5 3$0 <br /> alysis m-ide? Yes C2No ❑ If yes by whom' City zip <br /> avers electric log made" Yes ❑ to C) If ,es ittach cops to this report License No 1 Date of this repo <br /> DWR 188 (REV 7 7c) 1F ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />