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111GINAL. STATE OF CALIFORNIA DO not fill in eDWR THE RESOURCES AGENCY p' DEPARTMENT OF WATER RESOURCES No. 154216 of Intent No WATER WELL DRILLERS REPORT o�a n e n O t e r m i t State Well No Permite g p Pent No or Dat Other %tie11 Na OWNER Name Dou Wilson Pump & Irrig. Sys. (I2) WELL LOG �'' 2�i1� � '�2� qq � rt Total depue.,�;.1_ft Depth of completed we11..4L,Lft tress P . 0 . Box 602 2 from It to ft Formation (Describe b% color character size or matenal) Ca Z,p 95376 - LO TIO��``77 OF WELL (See mstnlctions) _ Intl an U o a q u i n-_ _—Owners Well umber 30 Saria 11 address if different from above 11000 W. Clover 3 0 - 40 C I a vnship Tracy Range Sectio 40 - 46 Sand tance from cities roads, railroads fences etc '/4 Mi . West -of 4 6 - 200 CIa 200 - 207 Grave south side 207 - ay (3) TYPE OF WORK New veli k Deepening ❑ - RM'iIIStructrnn ❑ - Reconditioning ❑ - Honzontal Well ❑ - Destruction ❑ (Describe - destruction materials and procedures in Item 12) - (4) PROPOSED USE - Domestic X] _ lmgahnn ❑ _ Industrial ❑ Test Well ❑ - ` Stock 0 - Municipal ❑ WELL LOCATION SKETCH Otherpp ❑ & - EQUIPMENT (6) GRAVEL PACK Sand - an Ex Reverse ❑ 1 es CM No ❑ Size G r a V e I _ bl111 e E3Air ❑ Diameter of brim 1 - ier ❑ Bucket ❑ Packed from _0 to_ 2 5 tt - CASING INSTALLED (8) PERFORATIONS - el © Plastic ER Concrete ❑ Type of perforation or size of screen - - From To Dia Gage or From To Slot ft ft in Wall ft ft s.ze - 0 215 6 160 195 215 Screen - WELL SEAL IS surface sanitary seal provided? Yes It No ❑ If yes, to depth-5 0 ft - re strata sealed against pollution" Yes ❑ No E] Interval ..�ft - thod of sealingB e n t o n i t e Work start19 Completed IS 0) WATER LEVELS WELL DRILLER'S STATEMENT pth of first water, If know q p This well was drilled under my jurisdiction and this report is true to the est of mg mcling level after well completion 1 U ft knowledge and belief 1) WELL TESTS SIG'%Eo lL�O L9 well test made" Yes ❑ No XJ If yes by whomv (Well Driller) pest Pump E] Bailer C) Air lift [I NAME 4 p water at start of test ft At qnI;L of test ft (Person firm, or corporation) (Typed or printed) Address 3 5 2 5 P EL AC117 A L E A U E _ harge�al/nun after hours Water tempgrp — cal analysis made' Yesv r City. MODEST 0 , CA � Zip 9535-6.- ❑ No �j If yes by whom '7 is electric log made" Yes ❑ No X1 If•es attach copy to this report �Limme No 2 908 1 3_ _ _ nate of th,s repo QCT 3 - 1984 NR 186 (REV 7 76) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM r