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5RIGINAL STATE OF CALIFORNIA Do not Jill in <br /> THE RESOURCES AGENCY <br /> tie with DWR DEPARTMENT OF WATER RESOURCES No. 145677 <br /> of Intent \n 'WATER WELL DRILLERS REPORT ___ <br /> r7Q G L State 11 r•1' `, <br /> Permit No or D rfc_(.V�"2 C.J V . QL <br /> Other "e11 <br /> WNER \,me Ron Moore (12) WELL LOG Total deptlt_15_4t Depth of cerioipleted nt!i 1 ft <br /> rlrlress 12 Edward Ave. from ft to ft Fornioturrr tDescnhe ba color character srxe or muervil) <br />,t,_ Manteca, Ca . Zip—9533-6--o - 7 Sand <br />') LOCATION OF WELLSec fi <br /> - 10 Clay & shale <br /> � nt+ San Joa uin i <br /> �-- _(�%aner er c s \%ell l] Number 10 _15— Sand <br />( 11 address of different from ahoae 1 - 31 Clay <br /> a n+hip R iro.,e Section 7� 31 - 3 Blue c <br />]6 r+nte from titres nrids milroads fence+ etc 1 1 0 E y S l Hw 12 0 3 - � <br /> pst of McrK,1nley Ave . south side 38 - <br /> Samd <br /> Kb •,\, <br /> Clay <br /> (3) TYPE OF WORK: 56 r' 60 \Blue sand <br /> Neu 11 ell X Deepening, ❑ b0 4 Blue clay <br /> Reconstruction ❑ 64 _ 1,2 <br /> 8 Cly <br /> Re,ondtnoninx, ❑ 12,b - 131 Sand <br /> Horizontal 11 ell ❑ 1 Cly <br /> Destruction ❑ (Describe 1315-- - 1 7 Sand <br /> destruction materials a8$ <br /> procedures to Item 12) 1 - 142 Clay <br /> (4) PROPOSED\USEI 142 - San <br /> Domestic 144 , _ o Clay <br /> Irng2tlon ❑ - _ an <br /> Industmil ❑ _. <br /> f Test 11 ell ❑ 4 _ - <br /> Stock ❑ - <br /> Municipal ❑ - <br /> NVELL LOCATION SKETCH Other ❑ - <br /> A EQUIPMENT (6) GRAVEUPACK _ <br /> dgrY Cid Reaerae \ - r <br /> ❑ les�} \o ❑ Size <br /> ilrle ❑ Air ❑ i`atneter of bore1141 - <br /> ihrr ❑ Bucket ❑ Pa�L1� fr'om�tn����t � � - <br /> Y CASING INSTALLED rF('� (8) -PERFORATfbNS \+ L\ - <br /> tel ❑ Phstic Comer e\ Tape of perf>�a'ty or size of screen r -From To Dia G ge or Fr V To <br /> ft ft m Wall f\ ft l �<SIW - <br /> 60 12 1 LFk rid c t - <br />)1 WELL SEAL .`is surf-kce sinitin aezl provrdeO les No n If )es to depth-5Q. fi -- <br /> rL strata seiled igainst pollution' Ies ❑ No ❑ IntenA ft - <br /> rthod of sealin N%ork started 19 Completed 19 <br /> 10) WATER LEVELS N ELL DRILLERS STATE'MEN'T <br /> t pth of first as iter if know n- - ft <br /> This tree!! war drilled umy <br /> tinder prrrsdu rurind nd tio hreport h+i+ frac fhr bt sr nj 'Pig,ending level jfter cell completion__ 1 _ _It Anouledw and belief ) <br /> 1) WELL TESTS SIG\LII <br /> rs well teat m ode? Yes ❑ Nog1 If a t r h+ n hmo (M ell Driller) Co. Inc.pe of test pump C] Biller E] Air lift ❑ t iI+1AM -Hennin� ar�� os . Drilling CI <br />,pth to nater it start of teat ft At end of lest ft 1Person h n <br /> r Lrpnh <br /> ronnI (T+peti or printed) <br /> rge Snl/nun after. _ hours W,%ter temperature Address-3525 P ela nd a 1 e Ave <br /> ,1 ann!)sis m tdc2 Ycs ❑ No YS If yes b) %hom" CitypC1 e c�,if] C q_ - Zip - pp <br /> �. s U <br /> t frit lug made? Yes ❑ No X If+es attach copy to this report 14cense No Date of this nlx. <br /> t3 <br /> cONSECEITl <br /> (REV i 7G) IF ADDITIONAL SPACE IS NEEDED USE NEXT VELV NUMBERED FORM <br />