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STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill in <br /> File with DWR DEPARTMENT OF WATER RESOURCES .ti n <br /> t <br /> WATER WELL DRILLERS REPORT N0. ? <br /> ratite of Intent No <br /> State Well No �/� <br /> al Permit No or Wit Other Well NOO 15 sE' <br /> (1) OWNER Nanie {12) WELL LOG Iotal depth 15_ ft (ni-ripleied dtpth 135 ft <br /> Address from ft to ft Formation(Describe bN color 61173eter size or matt r al) <br /> Citi 711' 0 -- 2' Fill <br /> (2) LOCATION OF WELL (See instructions) — <br /> Countl Sail Joaquin O.+iitr s %k ell Number 2' — 1 0' ll <br /> Well address if different froma� 17566 Swanson Road - <br /> Townchip Manteca Itanze 0 Section 10' — 12' Clay <br /> Distance from cities roads railroads fences etc — ^ <br /> 12' — 17' <br /> 27' 35' \ Clay <br /> (3) Tl PE OF WORK <br /> • New Well 12� Deepening ❑ 35' - 45'\\ Sand <br /> 3C� Reconstruction Ll <br /> •- 45' - 60' ' XCla <br /> --- <br /> Reconditioning © — <br /> +� �'' Horizontal Well ❑ \` <br /> SE ~ , - 65' - S`and <br /> Destruction ❑ (Describe , <br /> destruction materials and pro ; = <br /> cedures in Item 12) t. <br /> t >r (4) PROPOSED L'S 65 ~_ 6 r _ Clay <br /> v Domestic \� t _ '— Sand <br /> H <br /> Irrigation _ <br /> Industrial �' � ❑ yt �/ <br /> ay <br /> Test Well \.` ❑ _ 7 Cl <br /> Mumcip41 ��� © 71 . 1 51 Sand <br /> er ` <br /> WELL LOCATION SKETCH ( ribe) �� —\ t _ w--113' <br /> Clay <br /> (5) EQUIPMENT $6) CRAVIE-L ACK — <br /> Rotary Ir Reverse ❑ `. l Nv {� Size - <br /> Cable Cl Air ❑ ete of bore <br /> other ❑ Buck e�Q c ram ,.50 u, 135 -R, _ -1 I <br /> (7) CASING INSTALLED (8) PERy6RAT1ONS f hh — 1 <br /> Stec! [ 33 Sand <br /> Plastic ❑ n Ty of[ Fo on or size of Q JV _ <br /> From T Cage or � � ��Z\ v "t I _ -14 t <br /> ft ft i Wall �' t"•� 'size <br /> 0 13 11 105 1 ' -152 (23 AY' <br /> (9) WELL SEAL - <br /> Waasurfavesanitarysealpro.ided� lesgl No ❑ If yes,lodepth 50 ft <br /> Were strata scaledagairistpollutitrno les ❑ No)Cl Interval -0_ ft — <br /> Method of seabng "f url, started Marc i g--U completed Marr_h9 1�2 <br /> (10) WATER LEVELS 1�'FL[ DIiII I FR'S STATEMENT <br /> Depth of first water if knoHrn _ 1 2' To 22' - ft <br /> Standing level afterxellcoTlplction (F This ux11 it>�yrMrffrrf�tnder tiny jurisdiction and this report is true to the <br /> ft Ix•s' of niy knr ,ledge and tx/it j <br /> (11) WELL Z ESTS signed <br /> Was%eii test madee Yes ❑ No [R if yes by whom r (l1 ell Driller) <br /> ype"I test Pump El Bailer ❑ Air lift ElNAN�F Ma-rt-in Pilm" Supply Inc <br /> ptb to W ater at start of test ft At t nd of lest It 6C b(Pereoie firm or evrporation )Ixd or printed) <br /> barge gal/rninafter hours Waltr Iemrx Lure Addre�s__ ,/�_Road <br /> mical analysis m2dt? Yes ❑ No ❑ If ves,h%whorn0 City Oakda 1 a 7.I P <br /> Was electric log made Yes El No © Ifvesattachcoptitathisreport License No 160-851Datcnflhisn!>rnrt 09 <br /> DWR ISO 1REV 12 set IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORINT 86 96355 <br />