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QUADRUPLICATE STATE OF CALIFORNIA DO tlOE A 7H <br /> Usetoe requirmply ements <br /> THE RESOURCES AGENCY j 3 1 1980 fill local requirements NN <br /> 175366 DEPARTMENT OF WATER RESO��CES 'QUIN mt,,,1PO- 083775 <br /> Notice of Intent No..--•9_1296 IL <br /> WATER WELL DRLERS nr14hTTH DIS t&Z No. <br /> Local Permit No. or Date Other Well No. <br /> Gerald Gibson <br /> (1) O 2g�I. yN l • (12) WELL LOG: Total depth 1 7. Depth of completed wrl 165 ft. <br /> Address D1 J from ft, to ft nrma ' D s <br /> ( cribe by color, character. size m material) <br /> City- • • gip _ <br /> i4 17 -t'lay <br /> (2) L(yjffIVaM� {SELL (S,, instructions): It? 35 obullu <br /> Cmmty ��-^� Owners Well Number <br /> 35 39 W- <br /> Well address ithlrent from bove_ <br /> Township a enc: <br /> es,etc <br /> llista� ,,ads, railroads,f- JAo • <br /> 6YI - <br /> - <br /> v <br /> d <br /> 971*11 — 1 <br /> (3) TYPE OF WORK: <br /> New Well�5 Deepening ❑ <br /> Recanatruction ❑ 126 - <br /> Reconditioning ❑ COai-se sand <br /> - <br /> Horizontal Well ❑ 11? MAU <br /> Destruction ❑ (Dcscri e - 154 n <br /> destruction aterials <br /> procedures in Item <br /> (4) PROPOSED 156 z,. M% San <br /> Domestic - <br /> IrriKntion O ❑ <br /> Industrial \ ❑ - <br /> k oil cover was installed on <br /> T Well J ❑ - responsiblfor <br /> s _ r <br /> Municip <br /> jiz <br /> WELL LOCATION SKETCH Other ❑ - <br /> (i) EQUI <br /> PMENT: (6) GLIAACK: <br /> But., O Reverse ElNo Siz <br /> Cahlc ❑ Air ❑ r of lm 39� - <br /> Other ❑ Bucket ❑ nm [ <br /> (7) CASING INSTALLED: (8) PERF - <br /> Steel ❑ Plastic Co Type of pe or a of scree - <br /> From To Dia. Ga r F To <br /> f f Iviii f . f S' - <br /> (9) WELL SEAL: - <br /> \Vas mduce sanitary .veal provided? Yes No ❑ if yes, to depth 50 R. - <br /> Were strata sealed against poj&jis js Cj No jl� Interval R. - 79 79 <br /> Method of sea' e Work started 19 Completed 19__ <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if know ft This well was drilled under nqt juri.�di(nou and thin resort is true to the hest of my <br /> Standing level after well completio.+ R. knowledge and helivf. -+--^" <br /> (11) WELL TESTS: SIGNED ,ry�r {�.,� IR�I{r�1�,,� <br /> Was well test made? Yes ❑ No1S If yes, by whom? PariCvo Well DMP++••Sl Inc. <br /> Type of test Pump ❑ Bailer ❑ Air lift ❑ NAME <br /> Depth to water at start of teat R At end of test ft 31450re9w, fi !a( printed) <br /> Discharge mal/min after hours Water temperatureAddress <br /> Oakdale. Calif. . <br /> Chemical analysis made? Yes ❑ No ❑ If yes, by whom? City�3.33;114 zz; V719" <br /> Was electric log made? Yes ❑ No ❑ If yes, attach copy to this report License No. Date of this res rt <br /> DWR 198 (REV.7-'re) IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br /> i it <br /> I <br />