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mss/( --- <br /> ' STATE OF CALIFORNIA Do Not Fill In <br /> ORIGINAL THE RESOURCES AGENCY <br /> File with D%VR DEPARTMENT OF WATER RESOURCES N? 125393 <br /> WATER WELL DRILLERS REPORT state Well N <br /> IOtho ell No j 5�20Z�b <br /> OWNER: (I]) WELL LOG. o <br /> ante �fr l Tot.1 depth gi (� Et Depth of completed well (j it <br /> Address 1770 Z - E3try 120 Formation Drsrrrbe bs rofor rhrrarlrr ir.r aJ nerrnal •.d+rr.rr.rr <br /> (2) LOCATION OF WELL <br /> Cote n+TSm JnaauinRs nee s number if.ny P— 1 Shal <br /> Townsh+p Range and Secs+on "F' 11-18 C <br /> U+ttance from reties roads —1—ds e 7 f1 4 %r ` 8 ('1 a r shale <br /> i CZ f i Lic <br /> K y 1 1 Bl. clay <br /> (3) TYPE OF WORK (check) 41 —Cr7 <br /> New Well 2 Deepening © Reconditioning ❑ Destroying D 57—?9C ^tr <br /> If destruction describe material and procedure in!fent it n <br /> (4) PROPOSED USE (check) (S) EQUIPMENT Clay <br /> Domestic :K] Industrial ❑ Municipal ❑ Rotary5-1 5Q <br /> a <br /> Irrigation ❑ Test Well E] Other E] Cable ❑ 'r,0_1 <br /> Other ❑ <br /> (6) CASING INSTALLED <br /> STEEL x OTHER If gravel packed <br /> SINGLE DOUBLE ❑ <br /> Gage Dsame•er <br /> From l u or of From To <br /> ft ti Durn Wall Bore ft ft <br /> r K <br /> h <br /> Aft, .hoe yr .01 —g 5,ze of eravel pen <br /> nbe win[ <br /> (7) PERFORATIONS OR SCREEN <br /> Type of perlan+mn ter name of screen slot <br /> Perf Rows <br /> From To per per Size <br /> ft ft row ft in x in <br /> it <br /> (8) CONSTRUCTION <br /> Wa,a aurl.cr unitary seal pro,+ded s Yrs M No ❑ To what depth it <br /> Were any stnu araled against pollutions Yrs ❑ No❑ If yrs note depth of strata <br /> Fru it +o fs <br /> yrom <br /> It to ft Work started —2 19 75 completed 19 <br /> %I-'hod or—1-g _ WELL DRILLER S STATEMENT <br /> (9) WATER LEVELS This well was drilled under m) furisdimon and 1hiT rcpurt is true to the hest <br /> of my knowledgt and belief <br /> Uepth at which water was brat fo—d +f known it <br /> stand-it level before perf.,—.g tf known ft NAME Hennin SBroS . Drilling Co. Inc o <br /> (1 erson farm or corporation) (T)ped or prrojed) <br /> f[andsng leve[ ober per fora ting and d[�CIUp+RF 16 ft <br /> (10) WELL TESTS Address 2500 14. Rumble Rd. <br /> Waa pump tesE made? ,ret ❑ No ffe 1f yes by whom? Modesto Calf 223509 <br /> l d ical linin with fr drawdown after hrs (SIGNED) <br /> peraturt of caner Was a chemical analyst made? Yts ❑ fWelf Drriirr,No <br /> eetr+e los made of well? Yet ClNo If yes atuch copy License No P 90813 .Dated 6-1 2 ' 19-75 <br /> C0t'r - f 7�-t �O--7 SKETCH LOCATION OF WELL. ON REVERSE SIDE CO 1F1-)-NiT1AL [O <br /> Fdater Codi SeG. Io15:' 17atar Code Sec. 13752 <br /> DWR 188 a RrV 9 601 07133 7110• 7i 70M TR7. t os► <br />