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Clark Well & Equipment Co., Inc. <br />Contractor's Report <br />(1) OWNER: <br />Name <br />Address <br />(2) LOCATION OF WELL: <br />county San ,Toaq1T�'n Dwne', Na. T)ni t#5 <br />5", N., <br />(3) TYPE OF WORK (check) <br />New well K] Deepening ❑ Reconditioning ❑ Abandon Cl <br />If abandonment. describe materiel and procedure In Item If <br />(G) PROPOSED USE (check) (S) EQUIPMENT: <br />Domestic ❑ Industrial ❑ Municipal 70 Rotary ❑ <br />Irrigatlon ❑ Test Well ❑ Other ❑ Cable ❑ <br />(6) CASING INSTALLED: I If gravel packed <br />Single ❑ <br />Double ❑ <br />Drawn down. <br />Gage <br />From <br />fi. to ft. <br />Diem. <br />or <br />Wall <br />0 <br />100 <br />24" <br />0 <br />0 <br />280 <br />20" <br />.250 <br />0 <br />452 <br />16" <br />1312 <br />279 <br />584 <br />14" <br />.209 <br />Descrlbe <br />Diameter from to <br />of bore h. h. <br />30" 0 '' 100 „ <br />241, 0 340 " <br />20" 340 " 02 " <br />14H 502 " 584 " <br />(7) PERFORATIONS: <br />Type of per <br />foration used Roscoe Mose/Milled Slot <br />Size of perforations In., length, by In. <br />From ft. to ft. Pert. per now Rows per ft. <br />292 332 Full -Flow <br />352 392 standard Flow <br />412 2 MR -Flow <br />-4�3-9479 Mi ed Slot <br />99 519, 559-579 ar ar <br />(8) CONSTRUCTION: <br />To whet <br />Was a surface sanitary seal provided? &ziYes No❑ tleprti iQo n. <br />Were any strata sealed agonist pollution? Yes Q No It yes, rota depth of strata <br />From hto h. <br />Method of Sealing 9 Sack Mix <br />(9) WATER LEVEL: n. <br />(10) WELL TEST By <br />Water pomped <br />G.P.M. <br />Drawn down. <br />It. <br />Total fit <br />ft. <br />Yield of well <br />G.P.M./ft. <br />H.P. <br />Temperature al water Chamleff analysis <br />We. electric lag meds at wall? n Yn n No <br />(11) WELL LOG: <br />Total depth 635 ft. Depth of completed well It. <br />&AMUS �� <br />/ S M I PC I A(n�—(}(p <br />Work started19 G Cpmple`(ed 19 <br />CONTRACTOR'S STATEMENT: <br />This well was drilled under my jurisdiction and this report is true to the best <br />of my knowledge and belief. <br />NAME Clark Well & Equipment Co., Inc. <br />Address 2024 East Charter Way <br />Stockton, CA 95205 <br />Licenae No.._..._._._..._._..._ _.Dated..__.. .... ........ _._. 19-.____._ <br />