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STATE OF CALIFORNIA Do not fill Ori <br /> GINAL THE RESOURCES AGENCY N <br /> W1 WR DEPARTMENT OF WATER RESOURCES No 129428 <br /> of t No 160902 WATER WELL DRILLERS REPORT state Well No D2iJo�E31 03 1 <br /> r ,,.t No or Date Other Well <br /> OWNER I�*am Oe O'�7 Oi le -Elk (12) WELL LOG Total depth-'70 �t Depth of completed weill90 ft <br /> ss 3907 E - Fremont from f- to ft. Formation (Describe by color character size or material} <br /> S�ackton, Calif . Zip 9520 0- 4 Xa-0-Fe- <br /> 32ay <br /> L CATI N OF WELL (See instructions) 3 ori <br /> y San JOa qu lIi Owner s Wen Number <br /> 3 3 ay c San avers <br /> address If different from 3Z_above _ 6an �� <br /> ship RangeSection <br /> ame <br /> address - YJay <br /> ice from cities roads railroads fences etc <br /> —77 <br /> 300 ' l\7a . of road - <br /> (3) TYPE OF WORK <br /> t� New well Jr-Deepening ❑ <br /> Reconstruction <br /> Reconditioning O <br /> t (� <br /> Honzontal Well ❑ ] <br /> Destruction [] (Describe <br /> destruction materials y <br /> procedures m Item 1 = _ l! <br /> vl' (4) PROPOSED ' <br /> v <br /> tr Domestic <br /> l"r'U Inegabon� \ ❑ (\1�\ <br /> Industrial X ❑ �\] \ `� <br /> Tes\Well ti� C] �,\A�proper-well cover was ins a ed <br /> e3rI4? st�� r �` pn zs, <br /> n Mum aj, resgansz er for any a_ ering or <br /> _ � ea I or casing. <br /> WELT. LOCATION SKETCH ` Other ❑ <br /> EQUIPMEN'T (6) GRAVEL PACK - <br /> w He�erse ❑ Yes N ❑ size <br /> pea <br /> ❑ Air ❑ Diameter of bore _ <br /> L) Bucket L_I Pacl.ed from <br /> CkSI„ G INSTALLEI? (S) PEBTIIS� <br /> ❑ l'listsc F_'� Concrete ❑ Type of perforation or size (If screen - <br /> I _ <br /> lo Dia C1ge or From To Slot <br /> t ft In I Wall ft ft s.ze # - <br /> vi90 j <br /> �t ELL SE AL _ <br /> surfzcc 4imtir %ezl im)vided*� ]es 1:9 '\o [] If }es to depth—tt - <br /> strltl sealed I.-ainst pol]ution' les ❑ No 9 Intenal ft <br /> od of seahns Work Complet <br /> start I I8 <br /> WATER LEVELS WELL DRILLER'S STATEMENT <br /> h of first eater if loran% R Thu even ed r my isd,ction nd r repo is a to the best of -13iiDg letel after xCll camp]eho ft Li <br /> 1 rtnw[edge 4nd <br /> i <br /> S'4'ELL TESTS Sicl.lSn ( Driller) <br /> well test made” Yes ❑ No If yes by whom <br /> of test- - Pump ❑ Bailer © Air hft El N,AN! Panero Well Drillln :-3nc o <br /> h r asft_ - . At nd of test, it (Person.;firm,or corporahoa)'(Typed or panted) <br /> tet tart of test <br /> e Ti-ee Road— <br /> !t- Address 3"T 0 on <br /> a -gBl�_ aftwr hours l'-Water temperaittre Oakdale,e Calif-. zip <br /> - - Y / <br /> rriade' Yes ❑- No De If`yes,by whcrri" tarty �` 5/15!78 <br /> E7��. <br /> tic iog mad=° Yes ��` No ❑ If yes attach copy to thss report License I�T �aelrof'tIi's report_ r-- <br /> i'Ti rtEv i->cy 11` A&5[TIONA[ SPACE IS NEE=DED U9E NEXT COT�ISECl3TIVELY t UMB1=R£D4 SRM <br /> .,.- - - -�-• - ;fir , - F ' _ P _,. <br />