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I '.�s rr <br /> QUADRUPLICATE 11STATE OF CALIFORNIA DO IIOt fill U: <br /> Use to comply With THE RESOURCES AGENCY <br /> local requirements DEPARTMENT OF WATER RESOURCES No. 065071 <br /> Notice of Intent No. p WATER WELL DRILLERS REPORT State WI 11 N.,, <br /> Local Permit No. or Date _41 O 9 Other Well No. <br /> (1) OWNER: Narne 3a+es Burlupoftorman I s Nater (12) WELL LOG: Total aeptM—ft. Depth of rompleted wen 185 ft. <br /> Address 2120 Wilcox Rd. Sys• from ft. to ft. Formation (Desert by color, character, size or material) <br /> City- Stockton, a - P <br /> (2) L�CAT39NN ON WELL (See instructions): ) - 0 8n rare <br /> County any ji Owner's Well Number <br /> Well address if different from above 9030 N. Ashley Ln. 400 - 65 Clay <br /> Township Range Sectio 65 — 72 Gravel <br /> Distance frorailroads.m cities, roads,railrds,fences,etc. 72 — 100 C 1 <br /> 100 - 105 San <br /> 05 - aay <br /> ne an rare <br /> (3) TYPE OF WORK: y <br /> New Well 4 Deepening ❑ <br /> Reconstruction ❑ — <br /> Reconditioning ❑ — <br /> Horizontal Well El <br /> Destruurion ❑teri(Descri e — <br /> destructinn maals <br /> procedures in Item <br /> (4) PROPOSED <br /> Domestic — <br /> Irsigadnn O ❑ <br /> Industrial \ ❑ — <br /> We71 J ❑ - <br /> St. — <br /> Municip <br /> WELL LOCATION SKETCH Other ❑ — <br /> (5) EQUIPMENT: (8) CAA ACK: — <br /> Rotary X) Reverse ❑ No S' <br /> Cable ❑ Air Elr of bore 12 — <br /> Other ❑ Bucket [E] t 165 <br /> (7) CASING INSTALLED: (8) PERFORA 1 — <br /> Must El Plastic�j Co a Type of pe o+ a of scree — <br /> From To Dia. Ga r F To - <br /> ft. ft i . Wall ft. ft. _ <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yes X No ❑ If yes, to depth—.&D—ft. <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval ft. <br /> Method of scaling Work .eta • 419 87 Complet 19_ <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if known ft. This well mu drilled ,adrr our jurisdiction and thin report i.. titre to the best of my <br /> Standing level after well completion 72 g, knowledge and belief. <br /> (11) WELL TESTS: SIGNED <br /> Was well test made? Yes ❑ No X7 If yes, by whom? (Well Driller) <br /> Type of test Pump El Bailer E] Air lift ❑ NAME KENNING�S BROS. DRILLING CO. • INC. <br /> Depth to water 8t start of los ft. At end of test ft 3525(Pf'CLIt 6xy.CnatjTyped or printed) <br /> Discbarge gal/min after hours Water temperatureAddress p(ti (�C /A� Ct <br /> Chemical analysis =de? Yes ❑ No F If yes, by whum7 City MOD/EtSTO, CA Tp 95356 p <br /> Was electric ]og made? Yes ❑ No IF yes, attach copy to this report License No. 270813 Date of this repot Ar R. 6, 1907 T <br /> DWR 188 1REV. 1.76) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />