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ORIGINAL WATER WELL DRILLERS REPO"tr"� Do Not Fill Ix <br /> 1`116 OrlpIna i,Duplif:ate and Triplicate wild the (seearaaa 70749,7077.;1071,V....cod,) N? 3$8 6 8 <br /> REGIONAL WATER POLLUTION <br /> STATE OF CALIFORNIA State Well No.— <br /> CONTROL BOARD No �� --- - -- - <br /> flwrt apyroprrdr..ober) t <br /> / Ocher Well Not_./ <br /> 3f OWNER <br /> Glass <br /> (!1) WELL LOG <br /> ame l_1bbey—Owens—Ford Glass Co Total depth 199 Ir Depth of completed -CIE 155 tt <br /> Address 811 Madison Ave. Permat,oe Drsrrrbe by Holm rbarar4r trsr of mernlal ..l errrclrrr <br /> C a O 1, Ohio n It to 2 it 501-1 <br /> 7 jr Sand <br /> (2) LOCATION OF WELL r r <br /> u <br /> c. T ..ran Joaquin owner a number tf ane-- 10 E ',-,I n IS. Pea gzavel <br /> R F D or Srreer No <br /> Sec . 35 TIS R6Eqrxivpl <br /> 139 Cl F;y <br /> (3) TYPE OF WORK (check) <br /> New well 25 Deepettsng ❑ Recondlnonutg ❑ Abandon ❑ Y7 'y <br /> –r –F�9 1.8_H _ s <br /> If abandonment,deterrbe material and procedure in Item 11 <br /> (4) PROPOSED USE (check-) (5) EQUIPMENT <br /> Domestic ❑ Industrial [n Munlclpal ❑ Rotary ❑ <br /> Irrigation ❑ Test Well [❑ Other ❑ Cable <br /> Dug Well ❑ <br /> (6) CASING INSTALLED If gravel packed <br /> SINGLE K] DOUBLE i� Gags <br /> or Diameter from to <br /> From it to it Dram mall of Bore it it <br /> +1 195 14 #lis <br /> Type sad a,xe of shoe or well nag 5 8 X 5 S1zt of grad <br /> Dngnbe laat Welded <br /> (7) PERFORATIONS <br /> Type of perforator wod _ M1 <br /> C 111 s <br /> Size of perforauoas 3/16 ,n length by 1a _ <br /> From /t m it Perf per row Row.per It <br /> 118 135 8 <br /> 139 143 2 _e <br /> (8) CONSTRUCTION• <br /> Wn a surface sanitary real pro*tded? ❑ Yea l$No To what depth It <br /> Were nay strata.salad aguart pollution? ❑ Yes No If yes note depth of rcraea <br /> F1om It m1� <br /> it <br /> Method of Sealmjz Work starred Dec. 7 1,961 Corapined D B c 0 18 -1,61 <br /> (9) WATER LEVELS: WELL DRILLER'S STATEMENT <br /> This well was drilled trader my)urrsdrttron and this report it true to for best of <br /> Depth at which-star wu Set faa.d I1 tt my kola Pledge and belief <br /> ras ley"'before perforating it <br /> NAME Clark Well Drz 11i n9_ CO3 <br /> M level-fur perfonting it Orreon firm or i.orptraiion) or prewrrl) �— <br /> Addrefa <br /> 2024 LA� Cbextam Way <br />�) WELL TESTS: S o c k o <br /> Wu•piwp test made? QK Yes 0 No If To,by who-o? <br /> P G & E . <br /> Yields <br /> 735 ga1/stun .1t3 <br /> 59, a It draw da-o alter bra <br /> yc r� Writ Driller <br /> Tempersture of water Was a alcenrst+l anelym mp ade? Yes 0 No License No. _7 6 6 0 2 _ Dated_ J a ll 9 . 1962 <br /> Wu sleetrer 1e;made of-dJI El Y. :6 No Bassa 6 64 so.quire QQ aro DWR FoetM No 246 (REV 3 94) <br />