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QUAIWDLICATE _ <br /> Use to comply with �� STATE OF CALIFORNIA <br /> -local requirements THE RESOURCES AGENCY n Do not fill in <br /> DEPARTMENT OF WATER RESOURCES NO. 065062 <br /> NotiCe of Intent Nn WATER WELL DRILLERS REPORT <br /> Lural Permit No, or Date ���1 1 State Well No. <br /> Other%V ll No. <br /> (1) OWNER: Name, Cortvpassi Farms (12) WELL LOG: <br /> Address 11292 N. Al I ne Rd. Total depth 365 ft. Dept,of completed ,IL365 <br /> fro 1 Ft. to t 365 ft. <br /> Stockton Ca ft. Formation Des ri e by color, vhvracter, size ... material) <br /> ip <br /> (2) 1 AT0N OFs WELL (Seeinstructions): — 8 <br /> County an ©acu n Owner'sWell Number - an <br /> Well address if different from above <br /> Townsb'p Range - and <br /> at,Distance from cities, roads railroads fences,etc • or Q <br /> Ei ht Mile Rd. _ an <br /> ay <br /> - an <br /> (3) TYPE OF WORK: yr <br /> New Wall ; Deepening ❑ an - <br /> Reconstuction ❑ 121 - 4 C l a <br /> Reconditioning ❑ 34 - 1 Sa <br /> Horizontal Well ❑ - <br /> Destruction ❑ (Describe _ 165 <br /> destruction materials <br /> pnxedures in Item <br /> (4) PROPOSED 2 9 - Sand <br /> Domestic _ a <br /> Irrigaton - an <br /> Indmtriai'� ❑ <br /> Well O ❑ - 2 n <br /> Star 0 - 2 <br /> Maoac 295 - d <br /> WELL LOCATION SKETCH Other ❑ - a <br /> (S) EQUIPMENT: (t) GEA PACK: p _ an <br /> Y <br /> Rotary X] Nevene ❑ �] No s - 34 C i a <br /> Cable ❑ Air ❑ r of bore - 352 Sand <br /> Other ❑ Bucket ❑ 365 _ <br /> sand & Gravel <br /> (7) CASING INSTALLED (8) PERFORA 6 -365 Clay <br /> Steel Plastic ❑ C c Type td pe r n or• e of scree - <br /> NJ <br /> From T Dia. C r F To - <br /> ft. in. Wall f. ft. s' _ <br /> 0 - <br /> andar - <br /> uvere - <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yes ❑ No lt7 If yes, to depth ft <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval R. - <br /> Method of sealing Work start 19 Completed 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if known ft. This well was drilled under <br /> Standing level after well comphtio knowledge and belief, <br /> (11) WELL TESTS: SIGHE °y iurisJiotinn and this repay( is tufa to the best of mV <br /> D `` <br /> Was well test made? Yes Na ❑ If yes, by wham? (Well Drill ) <br /> Type of test Pump Bailer ❑ Air lift ❑ NAME KENNINGS BROS. DRILLING CO. , ING. <br /> Depth to water at start of test ft. SEE At end of test-ft (Pe n, firm, rporatinn) (Tvped or printed) <br /> Di--houge oaumin after home Water temperatvm Addres6_ 3525 PELAH➢ALE AVE_ <br /> Ch6mical analysis made? Yes ❑ No I if ATM 0 City MODEQSTgO• CA �;p 95356 <br /> Was electric Iog made'? Yes ❑ No If yes, attach copy to this report License No. 290813 Date of this repo t7 <br /> DWR 188 (REV.7-761 IF ADDITIONAL SPACE 15 NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />