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ORIGIN,kt WATER WELL DRILLERS REPORT Do ko't Fill In <br /> ee <br /> F119 Original,Duplicate and Triplicate with the (Seians 7076,70",yore,Water code) ,- N? 113583 <br /> REGIONAL WATER POLLUTIQN <br /> State Well No. /(c <br /> CONTROL BOARD No._..------------ THE RESOURCES AGENCY OF CALIFORNIA <br /> AIWIL t appropriate number) Other Well No__—------------- <br /> OWNER: (11) WELL LOG: <br /> Namev-�7 Oii11 ,:a".ter Seryice vow Total depth ft. Depth of completed well. it, <br /> Address F.—Ce .LSO". 1150 Formation:Describe by color,rbarecter,size of waierial,rad rtracsere. <br /> _ (t,to fr. <br /> Ca. 95108 <br /> (2) LOCATION OF WELL: <br /> CO1nty San Joao.ain Owner's number,if any— Z­,u " <br /> R.F.D.or Street No. In '*s_ y. l •' " <br /> 'µdr ~n �Snnnma� ��Seo din of 1o,Gation abandon b sealin i,dth <br /> ,� nt Fum�ad 2 cue s, <br /> " of 6 F;ack transit mix idth <br /> trQMJ Pi- fj= hotoM to <br /> (3) TYPE OF WORK (check): <br /> New well ❑ Deepening ❑ Reconditioning ❑ Abandon LJ „ <br /> If abandonment,describe material and procedure in Item 11. <br /> (4) PROPOSED USE (check): (S) EQUIPMENT: <br /> Domestic ❑ Industrial ❑ Municipal ❑ Rotary ❑ " <br /> Irrigation [7 Test Well ❑ Other ❑ Cable ❑ <br /> Dug Well ❑ <br /> (6) CASING INSTALLED: If gravel packed <br /> SINGLE ❑ DOUBLE ❑ Gage <br /> or Diameter from to •• <br /> From it.to ft- Di- Wall of Sore ft, ft. <br /> ;. <br /> Type and size of shot or well ring Size of gravel: <br /> Describe joint <br /> (7) PERFORATIONS: <br /> Type of perforator used <br /> S12e of perforations in.,length,by in <br /> From ft,to ft. Perf.per raw Rows per ft ' <br /> (8) CONSTRUCTION: - <br /> Was a surface san;[aey seal provided? ❑ Yes ❑ No To what depth ft. ' <br /> Were any strata sealed against pollution? ❑ Yes ❑ No If ycs,note depth of strata <br /> From s,.to <br /> f r. <br /> Method Of Sealing Work started 1! thpieted <br /> l9 <br /> (9) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth t which water was first found <br /> This was "411'd under my jarird' tion and this report is true to the best of <br /> aft. my k*6wledge and Vief. <br /> nding level before perforating <br /> ft. ri 1.1 n <br /> ME ?i FUMID ,:OiFa'c'tn <br /> ' � leerl afro prr(ora ting ft- •�Pefi rm.,or Cor tion) (7 <br /> -^-•— Address <br /> rso <br /> 1 .r .S l'•1Ve a yptd or printed) <br /> (10) WELL TESTS: nn <br /> Was a pump test made? C3 Yet _� L ,a050 O <br /> ❑ No If yet,by whom? <br /> Yield: <br /> gal-'min <br /> . with ft. draw down after hra' 1prlJ DrilJrr - -���••- ---"`[—'--- <br /> Temprrature of water Was a chemical analysis made? ❑ Yes ❑ No License No._6$_ _ry„_ ^-_ Dated--!' pG <br /> 'JLr,,t,_ <br /> Was electric log made of well? 0 Yes ❑ No ^------,19__...L.�._ <br /> 47641 a-at Batt osrtrs©4 Oro DWR 188 MEN,3-541 <br />