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QUADRUPLICATE STATE OF CALIFORNIA Do not fill in <br /> Use to comply with THE RESOURCES AGENCY <br /> local requirementsDEPARTMENT OF WATER RESOURCES No. 12042 <br /> Notice of Intent No.-159("14 WATER WELL DRILLERS REPORT state Well NO. <br /> Local Pemut No. or Date • 9 21 <br /> Other Well No. <br /> (I OWNER: Name Gerald albsen ( ) - 232 <br /> ) L yy.� I2 WELL LOG: Total dep 2 k. Depth of completed welL_k. <br /> Address 26 Starlit* W&Y from ft. to k.�kFonnation (Describe by color, character, size o material) <br /> Cih 1't"yNlit M11t Zip 0 - <br /> �r� <br /> (22) LOCATION OF WELL (s,fnstructio]u): 20- x <br /> 4 Clay <br /> County Stn J aquOwner's Well Number q <br /> 4- 36 NiiA <br /> Well address if different from above <br /> Township gauge—OOnl <br /> _1ba Read <br /> Distance from cities, roads, railroads,fences,eta tf • <br /> Packed SW <br /> (3) TYPE OF WORK: <br /> New Well Deepening ❑ <br /> I Reconstruction ❑ — <br /> Reconditioning ❑ _ <br /> Horizontal Well ❑ <br /> I Destruction ❑ (Describe — <br /> destruction materials <br /> procedures in It. = <br /> (4) PROPOSED <br /> Domestic <br /> irrigation <br /> Industrial <br /> Wel, O ❑ <br /> ❑ rp over was Installed <br /> st« n thleaA any am no <br /> hfunicip reSp._ or a er ng o <br /> tne am! or CaNLIZA9. <br /> WELL LOCATION SKETCH Other ❑ reID <br /> (5) EQUIPMENT: (8) CRA PACK: <br /> &rtary ❑ Reverse ❑ ❑ No S. <br /> G'ble 11Air ❑ r of bore — <br /> .Other ❑ Bucket ❑ m — <br /> (7) CASING INSTALLED (8) ERFOHA — <br /> Stee17J Plastic ❑ Cr c Type of pe or•ze of scree — <br /> From TDia.I r F To <br /> ft. f in. Wall f . ft. <br /> 010 - <br /> (9) WELL SEAL: <br /> Was surface sanitary seal presided? Yes ❑ No X If yes, to depth k. — <br /> Were strata sealed against pollution? Yes ❑ No X Inters.] <br /> Method of session Work started 19 Completer] 19_ <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, ifknowa ft- This well was drilled under m <br /> Standing leve] after weB completion ft. <br /> knowledge and belief. p imisdiction and ihfe report is rnsz to the beat n1 wry <br /> (11) WELL TESTS: SIGNED <br /> Was well test made? Yes ❑ No It If yes, by whom? (Well Driller) <br /> Type of test Pump ❑ Bailer❑ Air lift ❑ NAME Panero Well Drilling. Inc. <br /> Depth to water at start of teat k. At end of text k 3l s(Yrgr,yl ci>rsora[iyy) (_T.p r pri ed) <br /> Discharge nal/min aker hours }yAt 9.�M-Iljc <br /> ress {� • Lr0[1e j're <br /> Chemical analysis made? Yes ❑ No ❑ If y yT' ^tryloOakdale. Cialif• yip 9 3 1 <br /> Was elecMc tug made? Yes ❑ No ❑ Ifopy tase Ne. Date of this report 9 <br /> DWR 188 (FEv.7-761 IF ADDITIONAL E fj$ Ef tD, 11PIF N CONSECUTIVELY NUMBERED FORM <br /> m 97 a <br /> C!! <br /> N JOAQUIN LOCAL <br /> 1 '7 .LTH DISTRICT <br />