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ORIGINAL STATE OF CALIFORNIA Do not fill in <br /> THE RESOURCES AGENCY nt <br /> File with DWR DEPARTMENT OF WATER RESOURCES NO. 098347 <br /> Y <br /> Intent Nn WATER WELL DRILLERS REPORT _ <br /> State dell 1%u <br /> Permit No ur Date, �9 ) -Sl <br /> �- Other M ell No � <br /> «rNER I�m r ]M1 oorma n' s Water Systems (12) WELL LOG T,,t it Icpthl 40 It Dcpth of completed -ell ft <br /> lddress ____4243 Cherryland Ave• from ft to ft Fon]iatN,n (Deccnhe b• c 1hr chanctcr arc or mlttnal) <br /> c it, Stockton,, C 1,p 20 - <br /> ?) LOCATION OF WELL (See IIISUULt Dila 1 <br /> 18 - 7Q rlqv <br /> Ssn i u"1111t, i O%%ner s M ell lumber _ 77 san� <br /> �tll address of (Ieflereut Ir„m abo%e 11 ? cla s4\ <br /> cmnshtp Range Sectrn 1 G - q1 2 sand <br /> 1)rctanrr fr,,n cities roads raelroaei5 fin cs rlc_28010 1,1Y 120. 1 2 �' I � 41ay <br /> Zanteca , west of t Ed . on south 13 - 136 le z <br /> 136 1 R c ey <br /> (3) TYPE OF WORK 1' <br /> Ne%. \'1 ell ffi Deepening ❑ �/� <br /> Reconstruction ❑ <br /> Recond)teomng Ll <br /> Hunzontil M ell ❑ - --` <br /> De.truchon ❑ (Descnbe - <br /> destructlOn m itenals and <br /> procedures in Item 12) - <br /> (4) PROPOSED USE Domestic - <br /> Irrigation ❑ - <br /> Industrial ❑ - <br /> Test M ell ❑ - <br /> Stool, ❑{ _ <br /> Municipal ❑ <br /> WELL LOCATION SKETCH Other ❑ - <br /> 5) EQUIPMENT (B) GRAVEL PACK rA76odland - <br /> e <br /> iotar) M Re,erse C] Ies:x No E) Size - <br /> ible ❑ Air ❑ Dianeter of bore 1i <br /> Ither p Bucket ❑ Packed from Q tv�t - <br /> -} CASING INSTALLED (8) PERFORATIONS - <br />,nel ❑ Plastic ❑ Concrete 0 T.pe of perforahon or size of screen - <br /> From Tom Dia Gage`�r F DLA,\ _ To Ws' <br /> ft ft( 'In Wall t��\� ft �fS.Z6 - <br /> 0 140" 6,, 160 120" 140 '­s6 een - <br /> 9) WELL SEAL /� <br /> las suncce camtan seal pm,lded7 Ies No ,^, if yes to dcpth 50 ft% - <br /> ere strata sealed unmst pollution° ]es {❑ No ❑ Interval ft - <br /> lethod of seahn \1 ork started 19 Completed _19- <br /> 10) <br /> 1910) WATER LEVELS 1\ELL DRILLERS STATEMENT <br /> �(pth of first ,rater If kno,%n...—.,- ft This well was drilled under my turlsdeateon and this report is tore to the ben nj ni'l <br /> tcnding level after well complet)o ft 4nowledge and b(elliief { /� <br /> 11) WELL TESTS <br /> ,, %%ell test made' los ;� \om If yes L, whom,' (Nell Dnller) <br /> Jx of test Pump a Btdvr CI Air lift,.❑ • NAMETHQAningsBros, Drilling CO. . Inc . <br /> )cpth to water til start of test ft At cnd of test ft (Person firm or carpnration) (Typed or printed) <br /> t`arge_ mal/mm after hours NVater temperature Address 2 os <br /> ,+Cal analysis made2 yes [] Igo]� If yes by whom' y�LtY Modesto C a T O ,jI �Z p 0 <br /> ,zs leetne los; made' Yes ❑ NoM If %es attach copy to this re rt � Lec'ile-No 290813 3 Date oIt}us <br /> r L <br /> '16(#W <br /> ` -- <br /> 8 I--- > ls) IF ADDITIONAL SPACE IS NEEDED US£ N IV CUTIVELY NUMETFORM <br /> I `` <br />