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Township Range Section__
<br />° Distance from cities, roads, railroads, fences, etc arne address
<br />190 - 148
<br />0 - 190 Xxicitin well
<br />sand
<br />ORIGINAL
<br />rile with DWR
<br />e of Intent No WI-Permit No. or Date 81-323
<br />STATE OF CALIFORNIA
<br />THE RESOURCES AGENCY L K
<br />DEPARTMENT OF WATER RESOURCES
<br />WATER WELL DRILLERS REPORT
<br />Do not fill in
<br />No. 097949
<br />State Well No
<br />Other Well No°.?iald -6Z1-7,Z1 .
<br />(12) WELL LOG: Total depth 7t Depth of completed well 176 ft.
<br />from ft. to ft. Formation (Describe by color, character, size or material)
<br />LOCATION OF WELL (See instructions): `doaquin County.— Owner's Well Number
<br />Well address if different from above
<br />\,\/2
<br />A n_roper wel over 4'as installed on
<br />this well and not res onsible
<br />148 -17
<br />170 -17
<br />. for any terint\ or removing of t he %2 seal -or c ng .
<br />\\
<br />IN-\
<br />Cr.
<br />/A A4a1,,
<br />*pp
<br />V
<br />TYPE OF WORK:
<br />New Well 0 Deepening
<br />Reconstruction 1:3 - \\, <<> .
<br />' Reconditioning 0 c,..\ — _ \\7
<br />Horizontal Well 0 -''V.\ — ,•'\ '----
<br />Destruction 0 (Describe destruction
<br />_.._.-
<br />6--".• \
<br />s materials a d procedures in Item 1
<br />PROPOSED E`. ..... kt\•,,,A.
<br />C Domestic lk\N"
<br />..-
<br />(. Irrigation(> rikp N,
<br />Industrial \ 0
<br />1...: Well 0 ,\\ \\)—
<br />Stoel\c\ _ \,<
<br />\c\)) \'‘•:\i cr /.-, /7,---. ,7- ,,,...y); Municiliat..> 13•.' — --- \
<br />,i Other <-/' D WELL LOCATION SKETCH \\,,,
<br />EQUIPMENT:
<br />Rotary 0 Reverse 0
<br />Cable A lr 0 C.,:,.1,..D.,,,\i?......tsris\m
<br />Other 0 Bucket
<br />GRAN)EkPACK: </< —
<br />qes; 0 No Size C\
<br />er of bore
<br />
<br />Pki"..qc tom
<br />
<br />CASING INSTALLED:
<br />Steel a Plastic 0 Co c d•L;
<br />(8)\'‘PERFORAittS: — •
<br />Type of peRigTs tottze of screer —
<br />From
<br />ft.
<br />To, ft(c" Dia.
<br />>in.
<br />N Ga dr
<br />Wall
<br />Fr,ok\
<br />ft
<br />,._•.),) To A- -
<br />ft. >es
<br />0 120 Apting well ,..... -
<br />:14, 164 /4" 10 114- -,s.s> v
<br />> — \
<br />WELL SEAL —
<br />Was surfaces sanitary seal Yes 0 No CX If yes, to deptit______ft provided? —
<br />Were strata sealed against pollution? Yes 0 NoX:1 Interval ft. —
<br />Method of sealing Work started /6 19 81 Com leted_5 /LZ 19_6_3—
<br />WATER LEVELS:WELL
<br />Depth of first water, if known___ it
<br />DRILLER'S STATEMENT:
<br />This dr 1 p report is tole to the best of
<br />Standing level after well completion 23 ft.
<br />
<br />well was under un/ poi ction rm.
<br />
<br />knowledge an. .eli dr
<br />WELL TESTS: SICNFD 41..
<br />Was well test made? Yes 0 No Uc. If yes, by whom? (Well Dril -r)
<br />Type of test Pump 0 Bailer 0 Air lift 10 NAME Panero Well pri ling; Inc,
<br />Depth to water at start of test It. At end of test ft 6 6YPN ordan tea) 3l430"0:mtbeffd"Tie Address _...........ho sirs Water temperature 'rkarga _ gal/min after u Oakdale '-;alit. '9-5361
<br />City 7 •Zi ..'cal analysis made? Yes 0 No 0 If yes, by whom?
<br />Was log Yes H No 0 If to this electric made? yes, attach copy report 333114 1 ' License No Date of this report
<br />OWR 188 (REV. 7.76) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM
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