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♦ r <br /> i STATE �( - Do not fill it, <br /> � + OF CALIFORNIA <br /> ONGiNAL THE RESOURCES AGENCY 227007 O <br /> File with DWR DEPARTMENT OF WATER RESOURCES No. <br /> 'WATER WELL DRILLERS REPORT State \\ell Na � 1 _ <br /> r n! Intent \u PI 079-1 f� <br /> Prmvt \u ar Datr <br /> $1-4DCj Other\tell \n <br /> (1 ) O«-`,ER \ 140or-nr n f S •4a (12) WELL LOG Total depth 240ft Depth of completed %%ell -2 37 it <br /> �ddm 4243 Chert land Ave. from it to it Formahon (Describe by cidor chartcter size or m-terigl) <br /> cis <br /> ,toc�cton Calif . zip 0 - 3 To-�so2.l <br /> (2) LOCAT10\ OF NN ELL (See instmetions) Hardpan <br /> 3 —$ - $8j 1.0 sand <br /> C-ur-, Jai J Da u 3-n 0,,net s \\ell Number <br /> \\ell ."Id ns if ditfe,rnt from bole 15 - 20 la <br /> T, .n♦> a Hanie Sectio Zu - 30 I-ourse sand <br /> D::at.e In+m ours n+ads milmids fences ate JU - ay <br /> stoc'cton _ - 63 Sand <br /> ay <br /> an <br /> rr (a) TYPE OF ��ORx - ay <br /> J� few Well g Deepening ❑ 8Z - Y 1. an <br /> �^ Re[nnStnlLtinn ❑ 91 - ay <br /> Reconditioning ❑ 99 = 1:13 an <br /> Horizontal IA ell Cl 113 ay <br /> I:t6 153 band <br /> 1 , 't Destruction ❑ (Describe - <br /> destruction materials and <br /> procedures to Item 12) i59 t84 Sand <br /> - <br /> �`��f. ,., (4) PROPOSFD USE - <br /> t88 Gtay <br /> Domestic II _ <br /> 240 Szmd <br /> Irrigation [] <br /> Industrial ❑ -- -- <br /> Test Well ❑ - <br /> tock ❑ <br /> k ca _ <br /> Municipal Q ! <br /> WELL LOCATION SKETCH Other o <br /> (5) EQLIPMEhT (B) GRAVEL PACK - <br /> Rotary Reverse ❑ Yes CX No ❑ Sizepea <br /> - <br /> tl _ <br /> Cable [] Air ❑ Diameter of bore r��j - <br /> Other ❑ Bucket l] Packed from 5 0 to L —fL - <br /> (7) CASING I\STALLED (8) PERFORATIONS <br /> sawcut <br /> Steel .v Plastic)o Concrete ❑ Type of perforation or size of screen -From To Dia Gage or From To Slot - <br /> ft ft in Wall ft ft size <br /> 237 6 1 1~ 1. X - <br /> (9) WELL SEAL - <br /> Was surface sanitary sea) provided" Yes [N No [3 If yes, to depth 50 it Were strata sealed against pollution" Yes ❑ No E�< Interval t - <br /> Method of sealing Work start 19 C plet 19 <br /> (10) WATER LEVELS WELL DRILLER'S STATFINIENT <br /> Depth of first water if known it Th ts welt dulled u r m t rtsdict �R is report is true to the best o/ my <br /> Standing level after well completion ft 1 narcle a Ii <br /> i (11) WELL TESTS 5z E>? <br /> Was well test made" Yes ❑ Vo � If yes by ubom" (Well nller) <br /> Type of test Pump ❑ Bailer 0 Air lift Q NAME Y1� +� o <br /> Depth to water 3t start of test it At end of test ft 14,LP,Grsarb finny o0I1 e r L r) e) or nted) <br /> srbarge __ aa]/mut after hours Water temperature Address da e L 1 <br /> City Oakdale, Calif . ,p <br /> ,_all <br /> al anal>srs made" '<es Cj \o ❑ If yes by whoina 7-1Z1 <br /> as electric Ing made? Yes ❑ Vo Q If +es attach copy to this report License No Date of this repos* ---- ----- - <br /> oWR 168 tReV 7 713t 1F ADDITIONAL.SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br /> �i <br />