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ORIGINAL STATE OF CALIFORNIA Do not fill to <br /> THE RESOURCES AGENCY <br /> Ile with DWR DEPARTMENT OF WATER RESOURCES No 054329 <br /> of Intent No, WATER WELL DRILLERS REPORT <br /> State }tell No <br /> __r Yermet No or Date Other 1t ell \n <br /> WNER \a,,,e Art ( thmiller (12) WELL LOG Total depthj 50 ft Depth of completed µe11+ ' it <br />`ddress 4201 <br /> E 0 H 120 from ft to Ft Fnmiattnn i Desenhe b% a11nr character 517e nr materiel) <br /> it> Manteca CA Zip 95336 0 - 10 top s oat <br /> 2) LOCATION OF WELL (See mstntettnnO 1t 0 1 sand <br /> il <br /> r�unh San Joaquin Oµ N [ <br /> ners <br /> Nell Number 22 cla <br /> m 7 <br /> I ell address if different froabove 22 — 75 blue Band <br /> ' nahip Range Sectio 75 — 80 wood and-,sand <br />�1+tauce Irani cities raids railroads fencer etc Hwy <br /> 120 west Q 0 — $ salgd <br /> 1'1cK-innt-ly on south sidv, $b - 125 cla- `L <br /> 12 - 145 , s ani. <br /> 145 - 150 ,,sand shale <br /> (3) TYPE OF WORK <br /> \eas \t ell 4L, Deepening ❑ V <br /> Ret<mstructrnn ❑ _ ' <br /> Recondltinnmg ❑ _ <br /> Honzontal 14 ell ❑ - _ _— <br /> DestruMoin ❑ (Describe -destruction materials and <br /> procedures in Item 12) — <br /> (4) PROPOSED USE - <br /> Domestic <br /> Irrigation ❑ _ <br /> Industrial D _ <br /> Test At ell ❑ _ <br /> Stock ❑ <br /> Municipal <br /> MOW BELL LOCATION SKETCH Other <br /> S) EQUIPMENT (6) GRAVEL PACK _ <br /> otao M_ Reterse ❑ les 0� No ❑ SrzeB� rd e _ <br /> tble O Air ❑ \ Qtameter of bore 13 Its <br /> _ <br /> ther ❑ Bucket ❑ Packed from�90toj_5_� _ <br />-) CASING INSTALLED t 8) PERFORATIONS <br /> cel (❑ Plastic Q_ Cnncrgte,�_) Tape of perfniatitin nr size of screen !: — <br /> Froin To/— Dia Ga � r FrOTo `S ate\ - <br /> ft ft"' in Wall ftl\� ft <br /> 0 1 0\ g\ 9 0 12c)c) 1 5or zlle e n - <br />)) WELL SEAL _ <br /> is surface sandary set, pruwded� Sea rLj--' \u ❑ If vv, to depth 90ft — <br /> ere strata sealed against pollion" }es ❑ No ❑ Intcnal ft — <br /> t[hold of sealm dement Nark at iiied 19 <br /> Comp[ctcd 19 <br /> i0) WATER LEVELS «'ELL DRILLERS STATE4tENT <br /> lith of first "Ater if knmii it This u.t11 was drilled undar my itirrsdichon and deer report w tnie If, the hest N rrry <br /> hiding level after well completion ft xnnmledg a d be <br /> 11) WELL TESTS SIC"%EJ) n I?_J_ * <br /> o+ µell te,t made Its ❑ \ti g' if yes by µhom' (Well Driller) <br /> lie of test Pump ❑ Bailer ❑ Air hft Q N kNfE Henna n s Bros Drilling CO Inc. <br /> lith to wattr at start iif test ft At end of test f[ e n ire o co orabn ) (Typed c r printed) <br /> rge gal/min sifter hours [tater tempemhire Address 352� 'Te <br /> �anea�e avenue <br /> a] analysis made+ ) S a City Modesto_, Calif ornza __ 39C ❑ Nn (yY 1f yes by whom --- ,_Zip <br /> circ lug madt� }es ❑ No If es attach copy to thio report License Nn 290$ 3 Date of this repo �0 2 79 <br /> IlWe (REN 776) 1F ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />