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STATE OF CALIFORNIA <br /> QUADRUPLICATE THE RESOURCES AGENCY Do not fill in <br /> Use to comply with DEPARTMENT OF WATER RESOURCES <br /> local requirements WATER WELL DRILLERS REPORT No. 251146 <br /> Notice of Intent No. State Well No. <br /> Local Permit No.or Date 87-1871 Other Well No. <br /> (1) OWNER: Name So. San Joaquin Irr. DiS f12) WELL LOG: Total depth 1S4ft. Completed depth 190 ft. <br /> Address 11011 E Hwy 120 from ft. to ft. Formation(Describe by color,character,size or material) <br /> city Manteca Ca zip 95336 an <br /> (2) LOCATION OF WELL (See instructions): 23 — 26 i d j <br /> County San Joaquin Owner's Well Number — an <br /> Well address if different from above 21676 S. Airport 29 — 5 a <br /> Township Range Section 35 - 36 Sand <br /> Distance from cities,roads, railroads,fences,etc. Fig & Airport - 7 C a <br /> 0 san <br /> 6 <br /> an <br /> (3) TYPE OF WORK: 61 — 81 la ale Streaks <br /> New Well XX Deepening ❑ — o n <br /> Reconstruction ❑ 1116- AA3 III Shale <br /> 4 9 Sa d F r <br /> Reconditioning ❑ <br /> Horizontal Well ❑ 49- Cr 1 <br /> Destruction ❑ (Describe — I ST Sa <br /> destruction materials and pro- 190 014�v <br /> reduces in Item 12) <br /> (4) PROPOSED US _ <br /> Domestic _ <br /> Irrigation <br /> Industrial ❑ _ <br /> Test Well O ❑ — O <br /> Munici ❑ � � i� <br /> WELL LOCATION SKETCH rbe) — <br /> (5) EQUIPMENT: CAAV CK: <br /> Rotary ❑ Reverse Its No S' <br /> Cable ❑ Air ❑ [ of bore <br /> Otber ❑ Buck M fmm <br /> (7) CASING INSTALLED: (8) PE ATI <br /> Steel Plastic ❑ e Ty oI an or size of Q <br /> From D' Gage or of <br /> ft. f Wall I. size — <br /> (9) WELL SEAL: — <br /> Wassurfacesanitarysealprovided? Yes Et] No ❑ Ifyes,wdepth 24, fl. — <br /> Wereslratasealedagabarpollution? Yes ❑ No ❑ Interval fl. — <br /> Methodofsealing Work started_ I9 Completed 19— <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depthof first water,if known ft. <br /> This well was drilled under my jurisdiction and this report is Nue to the <br /> Standing level after well completion ft <br /> hest of my knowledge and belie!. j <br /> (11) WELL TESTS: Signed \ <br /> Was well test made? YesNo El n'yes,by whom? (Well Driller) <br /> Type of test Pump EX Bailer EJ An r t "rNMINGS p", <br /> Depth to water at start of test_ft. SEE Alend oftesl EL (Person,firm,or mrporalion ( y or print ) <br /> Discharge gal/minafter h�gT�p erterrveature Address _IqP& PFI ANI .'r�.t E <br /> Chemicalanalysismade? Yes ❑ No XJT f� om City MODEJTG G AZIP <br /> Was electric log made Yes ❑ No If yes,.Hach ropy to this report License No. Date of this report 198 7 <br /> IF AbDITIONAL SPACE 15 NEEDED. USE NEXT CONSEcunVELY NUMBERED FORM <br /> OWR tBB(REV. t2-Bel m gssss <br />