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\_� <br /> STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY DO not fill in <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT NO. n �; C <br /> Lice of Intent No Stale Well No <br /> al Permit Na or Date 89-42 Other Well No I l n` ?qT i <br /> OWNER Name Martin Teunissen (12) WELL LOC Tntil depth ft ('ompleted depth ft <br /> lddress 7762 E. West IZipoa Rd from ft to ft Formation(Des;cribe b) color character slzt or material) <br /> (Itv _ Manteca. Ca. - /1P 95336 p - 3 Top soil <br /> (2) LOCATION OF WELL (See Instructions) 3 - <br /> C'.ounty San Joaquin Owner%k%ell Number <br /> �N ell address if different from above 3866 Yosemite Blvd <br /> Township Manteca Range /r r —_ Section 30 - 42 Blue clay <br /> Distance from cities roads railroads. fences etc 42 - 54 Grey Rand And q1zavel <br /> — 69 Red spind �t <br /> 69 1.38 Brown <br /> (3) TYPE OF WORK 138 — 1 <br /> New Well ❑ Deepening ❑ 14 <br /> Reconstruction ❑ <br /> Reconditioning ❑ — <br /> Horizontal Well ❑ — <br /> Destruction ❑ (Describe <br /> destruction materials and pro- <br /> cedures in Item 12) <br /> r � — <br /> (4) PROPOSED USE- _ <br /> Domestic �❑ _ <br /> Irrigation <br /> l Industrial l \ ❑ / ` _ = <br /> Test Well 1 <br /> Murnclpel �' ❑ — <br /> Otber ❑ _ <br /> WELL LOCATION SkETCH </egso�be) _ <br /> (5) EQUIPMENT S64GRAVEf,11�CK <br /> Rotary ❑ Reverse ❑ liN\ No ❑ S1Ze ^ <br /> Cable ❑ Air ❑ eteiof bore ` <br /> Other L) Bucket'-�J �cl�gd from <br /> i <br /> (e) CASING INSTALLED (B) PER Ra TiON� — <br /> Steel ❑ Plastic El nZrete Ty of iron or size of r <br /> ft f <br /> From <br /> k1 \ �t Gage or <br /> 1 Wal] size <br /> J v <br /> (9) WELL SEAL - <br /> µas surface sanitary seal provided? 1 es ❑ No ❑ If yes to depth ft — <br /> %%ere strata sealed against pollution? yes ❑ No ❑ Interval ft — <br /> MLIbod of sealing Work started 19— Completed <br /> (10) WATER LEVELS WELL DRILLER'S STATEMENT <br /> Depth of first water if known ft <br /> l st nnil ouledgeand helve r pJt�njsrhrl�n and this repv1rl is frill to tilt <br /> Standing level after well completion ft <br /> (11) WELL TESTS tirgneci �i 1/irtJ ClZ Lill ,Bkkpr-- - <br /> Wa%well lest made? Yes ❑ No ❑ If)es.by wliorn? (11'cll Driller) <br /> pe of test Pump 1:1 Railer ❑ Air lift [jNAME CalWater I.rillln C.O. , Inc. <br /> pth to water at start of testfl At end of test ft 7 ��c,rson firm or mrporalion)(Typed or printed) <br /> #1,,arge gal/min af[cr liours Water temperature Address 300 S. roteal analysis made? Yes ElNo ❑ If yes,by whom? City `1 ur � �{' i — 71P_95,380 <br /> lectric log made Yes ❑ No ❑ If yes,attach cop)to this rtporl Licc rise No 321292 -- Date of this report — <br /> 21 -89 <br /> DWR ISO (REV 12 bet IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM 66 9'6335 <br />