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STATE OF CALIFORNIA Do not fill in <br /> Uft iwq— THE RESOURCES AGENCY <br /> load a DEPARTMENT OF WATER RESOURCES No. 227043 � <br /> Noticc of Intent No. _ WATER WELL DRILLERS REPORT state well No._ <br /> tical Permit No. or Date 81-878 Other Well Nn.__ <br /> (1) OWNER: Nam p Dolt* Peve1 asot Co. (12) WELL LOG: Totaldepth 30 ft. Depth of completed well_218 ft. <br /> Address P. ;. Pox 74111 from ft, m ft. Formation (Describe by color, charade,, sue or material) <br /> Ci ty Stockton, Calif. 990 zip - 6 T <br /> (2) LOCTIO�V OF WELL (See iDstmctions): Sand <br /> County oaQUilt Owner's We]]Number 13- 18 e 1 <br /> Well address if different from above 1`8 26 Sand <br /> Towvship Rarete Sectio 2E- 30 Clay <br /> Distance from cities,mads,railroads,fences,etc Acorn Ct. Lot 111 30- 44 Sand <br /> Stockton Calif, - 46 Clay <br /> - 53 San <br /> - Clay <br /> (3) TYPE OF WORK: - 32 Sand <br /> New Well [1C Deepening ❑ - Z57 - ay <br /> t Reconstruction ❑ - 121Sand <br /> /. <br /> / Reconditioning ❑ - IZ5 - ay <br /> ( rave Horizontal Well - ra � <br /> Destruction ❑ (Describe 15U- Itz ay <br /> destruction materials and <br /> 162 180 rm rave I <br /> procedures in Item 12) - <br /> 180' ' (4) PROPOSED USE: y <br /> Domestic C13I - ' <br /> Irrigation ❑ - <br /> 210 Chpy <br /> Industrial ❑ 2 V5 - " <br /> Test Well ❑ - <br /> Stock ❑ - <br /> Municipal ❑ T Draper well cover was installed en thka <br /> WELL Loc ION SKETCH Other ❑ well -and i alta not responsible for any alteHrsr <br /> (5) EQUD'MEN-f: (6) GRAVEL PACK: or rwnovinr of the seal or ca5tnn. <br /> Rotary ❑X Reverse ❑ Yes ❑A No ❑ Size__ Pee - <br /> Cable ❑ AG ❑ Diameter of bore 12 - <br /> Other ❑ Bucket ❑ Packed from 50 to 218 _1. - <br /> (7) CASING INSTALLED: (8) PERFORATIONS: - <br /> Steel Plastic ❑ Concrete ❑ Type d'iSW119.or size of screen - <br /> From To Dia- Gage or From To Slot - <br /> ft. ft. in. Wall ft. ft. size - <br /> 218 6 12 1 8 218 16"x - <br /> El <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yes OX No ❑ If yes, to depth-50--ft. <br /> Were strata sealed against pollution? Yes ❑ No Ek Interval ft. - <br /> Method of se Work siert 19 Comple[ 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if know h. This well was drilled under my iurudiction and tfst'axprm"tftme to the best of my <br /> Standing level after well ompletiny knowledge and belief,. <br /> (I1) WELL TESTS: SIGNED <br /> Was well test made? Yes ❑ No ❑X If yes, by wham? (well Duller) <br /> Type of test Pump ❑ Bailer ❑ Air lift ❑ NAME Panora Well Drill (nq,[ lne_ <br /> Depth to water at start of test ft At end of test k P o R or oration) ( yped or printed) <br /> waarosr 501 '9Z%Zrfttz a r'�. <br /> Dacbarge oat/min after hoots Water temperature 8 ole, Cal <br /> Chemical analyse made? Yes [I No ❑ If yes, by.whom? Ctt}• 7aP� <br /> 95361 <br /> Was electric log made? Yes ❑ No El If ves, attach copy to this report License No. Date of this rep ^ �j LLo <br /> DWR 188 (REV.7-76l IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />