Laserfiche WebLink
c � <br /> 6 s STATS OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill in <br /> Fite with DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT N4. 290902 <br /> t <br /> e of Intent No. State WellNo. <br /> I Permit No.or Date Other Well No.o W010 E0 3T <br /> (1) OWNER: Name ! L'. '� <br /> (I2) WELL LOG: Total depth ft.Completed depth ft. <br /> Address - from ft. to ft, Formation(Describe by color,character,size or material) <br /> City r,'"`� ✓ <br /> ( ) LQCATION JOF WELI,(See instructions): <br /> County ir4w( Ze� Owner's Well NumberAx)-7 <br /> Well address if diifffe1rent from above T <br /> Township Z.�LS�C Range Ae�F Section <br /> Distance from cities,roads,railroads,fences,etc. — <br /> Avw <br /> (3) 'TYPE OF WORK: <br /> New Well ❑ Deepening Q — <br /> Reconstruction <br /> Reconditioning Q <br /> Horizontal Well ® '- <br /> "" Destruction 0 (Describe <br /> destruction materials and pro- <br /> cedures in Item 12) <br /> (4) PROPOSED US _ <br /> Domestic <br /> Irrigation <br /> Industrial C1 <br /> Test Well p 4 <br /> Muolci _ O <br /> O er <br /> WELL LOCATION SKETCH Oe) <br /> (5) EQUIPMENT: 1 CRAV Zf CK: <br /> Rotary ❑ Reverse ❑ ® No i <br /> Cable ❑ Air ❑ C' eto fhore <br /> other E) Bucks aciced Som t <br /> (7)CASING INSTALLED: (8) PER OR TI — <br /> Steel ❑ Plastic ❑ » t Ty of fo ' nor sine of <br /> From T �i3i . Cage or T t ~ <br /> ft_ ft. i . Wall t size _ <br /> (n) WELL SEAL: <br /> Was surface sanitary seal provided? Yes Q No❑ If yc%todepth ft <br /> Were strata sealed against pollution? Yes ❑ No Ij Interval ft. — <br /> Methodefsealing Work started 19___,__ Completed 1fl� <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water.if known it. This welt runes drifted ander ne jurisdiction and this report is true to the <br /> Standing level after well completion ft best of my dge and Willy 'd <br /> (11) WELL TESTS: Signed <br /> Was well test made? Yes Q No Q If yea,by whom? (W ri]Eer) <br /> of test Pump a Boner ❑ Air lift ❑ NAME spEcTRu Ex <br /> epth to water at start of test ft. At eod of test ft (Person,firm,or corporation)(Typed or printed) <br /> scbarge^._____gal/min after hours Water temperature. Address- — 9825—E i4xR3.'LIa Sri'�Iay2 <br /> vii, 2 <br /> Chemical analysis made? Yes Q No ❑ Ifyes bywhom? City STOCKTnA,r Ca- ZIp 95205_ <br /> Was eleetric log made Yes Cl No © If es,attach cM tothisreport License No. 5S128 Date of this report <br /> DWR 188(REV. 12-ae) IF ADDITIONAL. SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM 86 96355 <br />