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RIGINAL STATE OF CALIFORNIA Do not fIu in <br /> THE RESOURCES AGENCY <br /> le with DWR DEPARTMENT OF WATER RESOURCES No. 174552 <br /> of Intent hit WATER WELL DRILLERS REPORT <br /> * State well N0 _ <br /> Jmak—ut ho or D rte <br /> Qihcr Nc31 1nQ <br /> WNER ar„r Eno 5 (12) WELL LOO- 2 0 0 2 0 0 <br /> p Total depth ft Depth of completed well ft <br /> arebb.,.,, 810 L Vwy 120 <br /> 2//��V fmm ft to ft Formatinn (Describe b, color character size or material) <br /> Lathrop , Ca _ Zip 95330 0 - 10 Top Soil <br /> i LOCATION OF WELL f St,e instructions) 10 - 26 Clay <br /> int) San JoAquin 0,ners \\ell Number 26 - 38 Coarse Blue San <br /> i <br /> - 70 Blue Cla <br /> 11 address if different from above 8 i <br /> i <br />,,nshrP 0/ Range_�i ' 5 Sccbml �y - <br /> tauee from .ities roads rminjads fenCeS etc North 0 f 1 20 90Bypass – <br /> _ <br /> nest side 127 - 140 Clay ` <br /> (3) TYPE OF WORK — 143 ,-, 8 Brown Clay <br /> \ew \5 ell L' Deepening ❑ <br /> — 148� a,154 Fair Sand <br /> Reconstruction p154 - 152 Brown Clay <br /> Reconditioning 0 159 - 164 Coarse Sand <br /> Horizontal \4 ell ❑ 164 - 178 Brown Clay <br /> Destruction ❑ (Describe 178 - 200 Coarse Sand <br /> destruction materials and <br /> procedures in Item 12} <br /> (4) PROPOSED USE w <br /> Domestic (� – <br /> Irrigation ❑ -- <br /> Industrial ❑ – <br /> k Test M ell ❑ – <br /> Stock ❑ – <br /> Municipal ❑ – <br /> WELL LOCATION SKETCH Other ❑ -- ` <br /> 1 EQUIPMENT (6) GRAVEL PACK Sand - <br /> tary Ex Reserse ❑ Ies;X3 No ❑ Size--G3 – <br /> bleII _ <br /> [] Air ❑ Diameter of bore ��� <br /> her ❑ Bucket ❑ Packed fmm 0 0 to__V – <br />) CASING INSTALLED (8) PERFORATIONS – <br /> el ❑ Plastic Concrete 0 Type of perforation or size of screen <br /> From To Dia Gage or Froin To ,Slot <br /> ft ft in Wall ft F` f size' - <br /> 0 200 8 h60 170 200 Screen - <br /> WELL SEAL n - <br /> s surface sanitary seal proiided? Ies CX No [I If %es to dept t>_LSZS.I—ft – <br /> ere strata sealed against pollution" Its ❑ No ❑ Interval ft – <br /> thud of sealing Work start I9 Completed - 19 <br /> 0) WATER LEVELS WELL DRILLERS STATEMENT <br /> pth of first water, if known —ft This well was drifted under my turisdretron and this report is i to the best of my <br /> indtng level after well compleborL.., 22 It knowledge and belief <br /> 1) WELL TESTS SIGNED <br />'c well test made' Its 0 No If )es b) wlinm' (Well Driller) <br /> pe of test Pump ❑ Bailer ❑ Air lift p NAME H E I f E l I N G S BROS . DRILLING CO . INC .NC - <br /> pith to water at start of test ft At end of test ft (Person F,rnr, or c0 ration – <br /> ) (Typed or printed) <br /> Address 3525 PELAtP�InZE AVE . <br />-^itarge oal/mitt afterhaters Water temperature City 11 ry D E S T O a L!'1 � Zip 9 5 3 5� <br /> teal analybis made" Yes C:1No)b If yea by whom? l+ <br /> the log made? Yes ❑ NoX] If )es attach copy to this report I License No ate of this report5 <br />.W18 (REV 7 74S) 1F ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />