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ORIGINAL STATE OF CALIFORNIA Do not fill to � <br /> V THE RESOURCE$ AGENCY <br /> File with DWR DEPARTMENT OF WATER RESOURCES No, 154084 <br /> 110 Intent No WATER WELL DRILLERS REPORT <br /> ]t itr %o <br /> _rnnt Vo or Due0 Q <br /> Other tt ell des <br /> I) OWNERr nne 1=a Ha t h enY (12) WELL LOG -r,>t it deptl, 3 70 it Depth of complete3571 <br /> 5 i1 <br /> address 1064 �3oodlaid Ave Suite H From ft to ft Fnrn}ttiun (Descnbe by color character size or rniterial) <br /> Ut, MOf4,;-Stn Zip 0 11 Tan Soil <br /> (2) LQCAJION OF WELL (See instnictions) <br /> uo,rnty a l Oag41Z 7 _ -Owner% Nl ell %umber. 1 t - 13t Sand Arid C lau <br /> ,t til iddress if dzfferent from ihove 24303 S Patterson Pass RadA t C <br /> Township_ Tra-V Rtn),e Section- �31 16, Sand a-d Gi yel <br /> Di,tance from cities roads raiimads fencei, etc <br /> 161 - 671 Clay <br /> 6 71 761 Sand <br /> (3) TYPE OF 'WORK <br /> Kew Well X Deepening ❑ 761 2941 Clay <br /> Ja TSecnnstructwn - <br /> Reconditioning ❑ 2941 - 297, <br /> Sand <br /> } � ti 1-lon�ontal 1d ell D '� �- <br /> r 0- <br /> 1Q Destruction Q (Desenbe 2979 - 3301 Clay <br /> i <br /> destruction m itenals and <br />.l procedures in Item 12) ]9 <br /> (4) PROPOSED USE 1101 - 3231 <br /> J ffi <br /> Domestic - <br /> `� [ lrrtgat&mx D333, 329, Sand and Small Gravel <br /> +� est Well 4 3391 - 3471 Green Clay fl <br /> Stock - <br />`x U11111cipal ❑ 3471 - 3551 Sand and small gavel � <br /> WELL LOCATION SKETCH Other <br /> ,5) EQI IPNIEtiT (B) GRAVFL PACK 3 71 - 3701 Caly <br /> tinta rY f� Revere Cl Yes 0 No 0 Size - <br /> C thle 0 Air ❑ Diameter of bore <br /> M <br /> Other D Bucket ❑ Packed <br /> N <br /> i! CASING INSTALLED (8) PERFORATIONS - t <br /> Steel Es Plastic 0 Concrete Tvpe of perforation or size of screen �From Ta",;: D>a Gage-or FrOn:�` �- TO ,Slot <br /> - <br /> ft ft t stn Wail ft�� ft. �Cs'ze� - <br /> 337*' 35.7' 16x4 - <br /> r � <br /> 9} WELL SEAL <br /> 4as surface sanitary seal prodded' Yes JO Nin ❑ If Yes to depth--5D-' ft <br /> Vere strata sealed against pollution" Yes ❑ No ❑ Interval -0« ft - <br /> fethod of sealxn - Nark started - 1$-3-4_ Complet <br /> 10) WATER LEVELS r � WELL DRILLERS STA.TEMENT <br /> +epth of First water if known - - - it This well m niader my runsdictroni and thin report +s true to Nie best of my <br /> ,andinx ]eve[ after well compleUo <br /> it kfwl ledge d chef <br /> 11) WELL TESTS 5lc��n <br /> ,s <br /> we <br /> [1 test m ides Yes ❑ No 0 If ,ea by whom' wa_ (NN ell Driller) <br /> pe of te.t Pump ❑ Hailer ❑ Air )tit p n N-k\IE-14artln P-G-np & Suon1`J Inc <br /> pth to water at start of cesY _0_ ft At end of iekt _(()_ ft I Verson hrm Or corporation) (Typed it printed} <br /> -0- -,l« ddress 5 =d Road _ <br /> gallmin after hours Water temperature Oakdale Zip 95361 <br /> nalysta mada� ]ea Q NO 1❑ If yrs by whanz� -0 City _ <br /> electne, lot; made? Yts D Vo 01f .es attach copv to this report License Nn �60'�5� nate of this report 1-23 � <br /> � <br /> VR 1aS (REV 7 76z IF ADDITIONAL SPACE lS NEEDED USE NEXT CONSECUTWELY NUMBERED FORM <br /> 1 <br /> � t - <br />