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STATE OF CALIFORNIA <br />THE RESOURCES AGENCY <br />oatotrtiu C �!!L�E'ARTMENT OF WATER RESOURCES <br />File with ®W! 'Plater Code Seca T4FR WELL DRILLERS REPORT <br />Do Not Fill In <br />° 57178 <br />S�WellNo. $E—Z1F�►1 <br />Other Well No <br />(1) OWNER: '�v }� I� b " p T, <br />!Name=Z=--n.,�_ o„., A ,` q <br />laN N U I fJ • <br />(1 1) WELL <br />Total depth <br />LOG: <br />199 <br />196 <br />fc. Depth of completed well f[. <br />Address 17 i�� H.e is rney Lane <br />Formation: Describe <br />by color, <br />cberecttr, ti.t of materiel, and structure <br />ft. t0 ft. <br />Lodi, 9 C riif • <br />(2) i <br />LOCATION ^ OF In <br />County San J `' a.o lA n Owner's number. if anv <br />0 <br />!//� <br />� -c <br />h <br />It <br />['i? r: <br />• <br />Township. Range, and Section `c" v.�. v • GG <br />�. <br />2y"., <br />^ t"ri ^_ " `^ c <br />- <br />Distance from cities, roads, railroads, eta Jou t n C id % o + Harney <br />72 <br />� 4 <br />t,,, <br />i '' _ - ^ v of v_a ^nts ? 9 <br />�ti <br />�J, <br />(3) TYPE OF WORK (check-): <br />New Well f� Deepening ❑ Reconditioning ❑ Destroying ❑ <br />If destruction, describe material and procedure in Item 11. <br />AL _ <br />1 n L, <br />c A �� ? <br />4 <br />1 - 1 �`� <br />r- " ^ . <br />r-- <br />1 ��0 - 1 ^-„ <br />•.�, _ ..l V?i gra <br />� :""'- � _ <br />v <br />(4) PROPOSED USE (check) : <br />Domestic � Industrial ❑ Municipal ❑ <br />Irrigation F7 Test Well C3Other E] <br />(S) EQUIPMENT: <br />Rotary ❑ <br />Cable <br />Other ❑ <br />17 � — <br />1 F 1T <br />1 64 1 P� <br />1 r?r - <br />�?'^;. ° r^Trgl <br />(6) CASING INSTALLED: <br />STEEL: OTHER: <br />SINGLE F� OOUBLE ❑ <br />Gage <br />From I'o or <br />ft. it. Diem. Wall <br />If gravel packed <br />Diameter <br />of From To <br />Bore ft. ft. <br />(1 r <br />12 12 <br />c^n�,a, to r -)e <br />Size ui ,hoe ue ..It ring: v ":3 Size of gravel: <br />Bu: <br />ue.aribe joint �;u :, -.,re <br />MwawtSec' <br />(7) PERFORATIONS OR SCREEN: <br />Type of oertora[iun or name of screen <br />From <br />it. <br />Perf. <br />To per <br />ft. row <br />Rows <br />per <br />ft. <br />Size <br />in. x in. <br />(a) CONSTRUCTION: /� <br />Was a ,uriace sanietry seat provided? Yes 1§ No C3 To what depth �50 ft. <br />Were anv ,true ,ealed against pollution? Yet Q No�t If yes, note depth of street <br />from ft. to ft. <br />From ft. to ft. <br />Work started <br />? <br />19 7 P Completed 7 P "i 19 72 <br />Method of ,eating re C e7-nntsWELL <br />DRILLER'S STATEMENT: <br />This well was drilled under my jurisdiction and this report is true to the best <br />of my knowledge and belief. <br />NAME Jo a:jcz rc It Jr. <br />(Person, firm. or corporation) (Typed or printed) <br />Address 1127r,- S, "Tan _ "Llen <br />(9) WATER LEVELS: <br />Depth at which water was first found. if known 120 ft. <br />Standing level before perforating. if known It. <br />Standing level after perforating and developing ft. <br />(10) WELL TESTS: <br />Was pump sale made? Yes ❑ No ❑ If yes. by whom? <br />n n jn n <br />o n ter,• Z 2s <br />` Temperature <br />Was electric <br />Was a Chemical analysis made? Yes ❑ No <br />made of well? Yes ❑ No <br />OWR 188 Intty. 9.6x1 <br />License No. 12277* Diced I9 72 <br />SKETCH LOCATION OF WELL ON REVERSE SIDE Plate D-1 <br />25119-950 5-4411 11004 TRIP AD Cup <br />