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QUADRUPLICATE STATE OF CALIFORNIA <br /> Use to comply with Do not fill in <br /> local requirements DEPARTMENT <br /> RESOURCES AGENCY IN�. O��wGl.�Lv�A <br /> DEPARTMENT OF WATER RESOURCES <br /> N,,tice of Intent Net. WAJ.tt AT WELL DRILLERS REPORT state Well No. <br /> Local Permit No, or Date r t _ <br /> Other Well No. • 1 <br /> 011and Seegers 12 22 22b— <br /> (1) OWNER: 1'vame ( } WELL LOG: 'I'utal dept}t. �t. Depth of completed .yell �tt. <br /> Address - S. n eca • frena ft, to ft. Formation (Describe by color, character, size or tnateririal) <br /> 8� • <br /> Cizip — Topsoil <br /> ey <br /> sand <br /> (2) Lr�Cs, T1i� JELL (See instructions): _ Ltd sand wt? <br /> Count}• ►7� u L4f t+ Owner's Well Number 3 51_ od <br /> - ` <br /> 41',11 address if different from above <br /> 65 Clay <br /> — 70 <br /> >.a <br /> Township-Range Set u,n <br /> Distance from ci'es,roads,raj Dads f ees, etc. ft rport a - • - 72 �1 <br /> south o ` Pers t+t�.y vestside 2 - 93 Fine sand <br /> 93 09' C ly <br /> 95 <br /> - '&V Sand <br /> - (3) TYPE OF WORK: 100 1 <br /> NetsWell Deepeninr� ❑ t ja - <br /> Reconstruction ❑ 150 - <br /> Reconditioning © - 115.5 Hl-ue se n <br /> Horizontal Well [] - 167 BJue clay <br /> ay <br /> Destrnetion ❑ (Describe -61 r`t,�+ II� <br /> destruction materials <br /> procedures in Item _ 1 - -Clay k <br /> (4) PROPOSED` 198 M,, S <br /> Domestic 196' Clm& <br /> - <br /> Irrigatitsn <br /> Industrial \\ ❑ - - <br /> T <br /> We" <br /> - <br /> Sttrc - <br />� Ivlunicip• - n <br /> WELL LOCATION SKETCH Other \,',,_ ❑ - _ 1+1 <br /> (S) EQUIPMENT: (6) GRAY ACK: R - <br /> Rotary, E] Reverse XNo Sizer. ` <br /> Cable ❑ Air ❑ r of hore--alfN - <br /> Other ❑ Bucket ❑ rout 0_ - <br /> - r <br /> (7) CASING INSTALLED: (6) PERFORAi`IO overs - <br /> Steel,A Plastic Co e Type e e e e - <br /> ) <br /> From To Dia. (:a r F To <<\ <br /> ft, f i Wall ft. ft. <br /> 0 22 16 178 ful-fl <br /> 1110 1 Z x2jiff <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yes ❑ No Z If yes, to depth ft. - <br /> ' Were strata sealed against pollution? Yes ❑ No ',❑ Interval ft. - <br /> YMethod of sealing Work startod 1 Completed 19- <br /> (19) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if know R- This well teas drilled tinder my jurisdiction and this report is trite to the best of my <br /> i <br /> Standing level after well completion 10 ft, ktwwledge and belief. <br /> (11) WELL TESTS: �j SIGNT'A <br /> r t� <br /> Was well test made:' Yes No [:1If yes, by whom? Rennin (Well Driller <br /> I ` <br /> Type of test Pump Bailer ❑ Air lift ❑IINAME Kennings Bros• Drilling CO••enc•II Depth to water at start of test ft. At end of test- 7 ft (Person, finu, or corllorati(n) (Tvped-printed) <br /> Discharge-190-gal/min after hours Water temperat re Address 3525 Pelandd le Ave, <br /> � Chemical analysis made? Yes ❑ No Z If yes, by whom"- city lead na -n q Coo zip 9 156 <br /> i <br /> Was electric log made? Yes 0 NoJX If yes, attach copy to this report License No, Date of this report 12-29-go <br /> DWR 188 (REV.7-78) IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />