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Gib, ICA■i STATE OF CALIFORNIA DO n0>`fill to <br /> use'-ae'rnQ�fyw� THE RESOURCES AGENCY <br /> local requh menti DEPARTMENT OF WATER RESOURCES No. 227040 <br /> Notice of Intent No. WATER WELL DRILLERS REPORT State Well No. <br /> Local Permit No. or Date ��=�� Other Well No. <br /> (1) OWNER: Nume Oa1La DevalO nt Co. (12) WELL LOG: Total dep [e Depth of completed we <br /> Address Pa Go Bot 7414 from ft. to ft Formation (Describe by mine, character, size or matcemij) <br /> �h Stockton. Calif. zip--95207 0 - b Adobe clay <br /> (2) LOCATION OF WELL (Seeinstructions): 6 - 12 Sand <br /> Coonty OaQFI n Owmres Well Number 12 - 16 C i aRLt/� <br /> Well address if different from above 16 - 25 SM/aR- <br /> TowushiP Range Sectio 25 — 36 Cay <br /> Distance from titles, roads, railroads,fens,etc Acarn Ct. Lot B - kO an <br /> Stockton. Calif. 4 - ay <br /> an <br /> ey <br /> (3) TYPE OF WORK: 57 - .,an <br /> New Well OX Deepening ❑ 79 - 84 ay <br /> Reconstruction ❑ 04 _. No sand <br /> Reconditioning ❑ 170 125 Clay <br /> Horizontal Well ❑ 125 - ' <br /> Dwtmctioa ❑ (Describe 156 160 <br /> desteactiun materials and 160 !89 Sand <br /> procedures in Item 12) 189 T093 Hay.- <br /> (4) PROPOSED USE: - <br /> Domestic I _ <br /> Irrigation ❑ _ <br /> Industrial ❑ _ <br /> Test.Well ❑ 6 proper well cover was installed on <br /> Steck ❑ this well and 1 am not responsible for <br /> Municipal ❑ any-altering or removing cf the ser) cr <br /> WELL LOCATION SKETCH[ I Other ❑ Cas rip- <br /> (5) EQUIPMENT: (8) GRAVEL PACK: - <br /> Rotary 0 Reverse ❑ Yes ❑X No ❑ Size - <br /> Cable ❑ Air ❑ Diameter of box - <br /> Other ❑ Bucket ❑ Packed - <br /> (7) CASING INSTALLED: (8) PERFORATIONS; - <br /> Steel ❑X Plastic C) Concrete ❑ Type of perttlratl Yr*tsize of screen - <br /> From To Dia. Gage or From To Slot - <br /> ft ft. in. Wall ft. ft. I size - <br /> 0 220 6 12 80 220- u t1 - <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yes ❑�t No ❑ If yes, to deptb_-S�a-ft. - <br /> Were strata sealed against pollution? Yef C No IAC Interval---ft. - <br /> Method of sealing Work start ILAW= Compin 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if ken ft This well was drilled under <br /> rap jurisdiction and this report is true to the best of my <br /> Standing level esker well completion - F, kunwledge and belief. <br /> (11) WELL TESTS: SIGNrn <br /> Was well test made? Yes ❑ No ❑ If yes, by whmn? (Well Driller) <br /> Type of test Pump ❑ Bailer❑ Air lift ❑ NAME <br /> Depth to water at start of teat ft. At end of test ft cRgLji61rrPainted) <br /> Discharge oal/min aRet xours Water temperature Address 3145() E. Lone Twee nved_ <br /> Chemical analysis made? Yes ❑ No ❑ If yes, by whom? Crry" Pak'f�i Calif. zips 3f� <br /> Was electric Ing made? Yes ❑ No ❑ If%es, attach copy to this report License No. ate of this report <br /> OWR 188 (XEV. 7.76) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />