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QUADRUPLICATE STATE OF CALIFORNI Do not <br /> Use to�mPly with JAN 9 19 9 f fill in <br /> loco ire <br /> THE RESOURCES AGENCY No. 085335 <br /> DEPARTMENT OF WATER RESOURCES <br /> Notice of Intent No-- WATER WELL DRILLERS JWOWUIN LOCAkeII No. <br /> Local Permit No. ar Date 7 —13 1 HEALTH DISTR& Well Na. /16-45`46/ <br /> (1) OWNER: Nome Al Fonseca (12) WELL LOG: Total depth 3�t. Depth of completed we>270 ft. <br /> Address 22695 ort Way from ft. to ft. Formation (Describe by ailor, character, size or material) <br /> cin. 1,1,nzeea, ce a Zip 0 - o so <br /> a - sandy clay <br /> (' ) LOLATIQi)[_gWLL (See instructions): Wel], 9 y <br /> County S0a6atA+ err"�aQ Ownai s Well Numbermot —i-9-- <br /> to - ' an <br /> Well address if different from above 1 p <br /> ff <br /> Township Range Sectio �k 20 = -23 asr <br /> Distance berm cities, roads, milmeds,fences,etc. Airport Way- 2 2 <br /> North of W R1 on Rd. ves 2 - 2 <br /> Airport Wa 2 - n <br /> - ay <br /> (3) TYPE OF WORK: J a <br /> New Well 3 Deepening ❑ y <br /> Reconstruction ❑ P7 - e $ <br /> Reconditioning ❑ - $. San s ree s <br /> Horizontal Well ❑ 2 <br /> Destnretion ❑ (Deseri e - t $y <br /> destmctinn ws,tereajs <br /> prrrcedures fn Item - a <br /> (4) PROPOSED 121e y <br /> Domestic - <br /> Irrigetin¢ O170 D;W <br /> IndusMal ❑ - <br /> Well ❑ lzl - 2 . - C1a 1 <br /> str 0 - 'Sand <br /> Mnmerp <br /> 233 2 Clay & sand strew s <br /> WELL LOCATION SEETCH other 240, - sand <br /> (.i) EQUIPMENT: (8) GRAV ACE: - 0 C y sae streaks <br /> Retary E] Reverse fl No Si z �V' Sand-1 ne <br /> Cable ❑ Air ❑ r ,f here - <br /> 270 <br /> Other ❑ Bucket ❑ <br /> (7) CASING INSTALLED: (B) PERFORA I - <br /> Steel ZPlastic ❑ Ca a Type mf pe or ze of scree - <br /> Fmm To Dia. Ca r F To <br /> ft. ft i . Wall ft. ft. - <br /> 2 1 2 i - <br /> 150 >1 <br /> (9) WELL SEAL: <br /> Was surface sanitaryseal provided? Yes a No ❑ If yes, to depth�2_—ft. - <br /> Were strata sealed ynst oltu'aYes o elntgIIj.___�_��ft - <br /> Method of sealitsGrp !i0 Ti6� 1� Work started 19 Cmnpkwd 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if known R This well was drilled under rep jurisdiction and this report is Ime to the best of my <br /> Standing level after well completio '2 R. knowledge and belie). <br /> (11) WELL TESTS: SIGNED- <br /> Was <br /> IGNED Was well test made? lies No ❑ If yes, by whmn? Well Driller) <br /> Type of text Pump Bailer ❑ Air lift ❑ NAME Hennings Bros. Drillinj Co,jne. <br /> Depth to wattAeeraat(tt� start of test ft At end of tsst�ft (Yerxnn firer, or cnmemtion) (Typed ur printed) <br /> Discharge—w�] ��Y�al/min afrer h¢vrs Water tempemtrue AddressP^elandale Ave. 2 <br /> Chenricat analysis made? Yes N n City )�OdeSto� Ca• Zip 35'� <br /> ❑ o fj If yes,attach <br /> wham. 12 q <br /> Was electric log mode? Yes � No ❑ if yes, attach n>py to this report License No. 290811 Date of this report <br /> 7 <br /> i DWR 188 Intv.gnat If ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />