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10RILINAL STATE OF CALIFORNIA <br /> 4W THERESOURCES AGENCY Do not fill In <br /> File with DR <br /> DEPARTMENT OF WATER RESOURCES No. 206209 <br /> N of Intent No 245951 WATER WELL DRILLERS REPORT <br /> rmu No or Date State Well No <br /> Oother Well No <br /> WNER +� <br /> v'tme Nestle Foods Cor oration (12 WELL <br /> Address 230 Industrial Avenue I'OC' Total deptl�_ft Depth of completed aelL 42 ft <br /> City Ripon, Cly from ft to ft Formahon (Describe by color chyioer size ur materml) <br /> Lip 95366 _ <br /> '(2) LOCATION OF WELL (see mstructlons) - <br /> CountyM-10 B <br /> Owners 1Vell Number - See Attached Log <br /> Wel]address if different from above <br /> Townslitp <br /> Rance 7 7 Sectio <br /> Distance from cities roads railroads fences, etc _ <br /> ' (3) TYPE OF WORK - <br /> New Well 00 Deepening ❑ _ <br /> See Attached Map Reconstruction ❑ - <br /> Reconditioning ❑ _ _ <br /> Horizontal <br /> Destruction ❑ (Describe <br /> destruction materials and t <br /> procedures in Item 12) _ _ - <br /> (4) PROPOSED USE <br /> Domestic ❑ <br /> ' Irrigation ❑ _ - <br /> Industrial ❑ _ <br /> Test Well <br /> Stock ❑; ♦ - ? <br /> Municipal ❑ <br /> WEE L LOCATION SKETCH Other Monitoring cX <br /> a <br /> (5) EQUIPMENT (8) GRAVEL PACK <br /> Rotary 0 Reverse ❑ Yes ffX63 No ❑ Size ` <br /> cableAu 9 i <br /> ❑ [� Diameter of bore inch � - <br /> Other <br /> ❑ Bucket ❑ Packed from— <br /> '(7) CASING INSTALLED (8) PERFORATIONS _ <br /> Steel ❑ Plastic [X Concrete ❑ Type of perforation or size of screen <br /> w <br /> From To ` Dia Gage or From 4 _ To Slot`-> - <br /> ft ft to Wall ft ft size ` <br /> Sch.4 22 42 .010 _ <br /> n� <br /> V(9) WELL SEAL. _ <br /> Was surface sanitary sea' provided? Yes [Y No ❑ If yes, to deptft <br /> Were strata sealed against pollution? Yes No ❑ Interval-5-18 _ <br /> Method of sealm <br /> Work <br /> W(10) WATER LEVELS s 19 Camplet ly$�- <br /> Depth of first water if known, WELL DRILLERS STATEMENT <br /> Standing level after well completion ft Thi 11 was drilled under my iurudictton and this report is true to the best of my <br /> �t knowledge and belief <br /> rET'),well <br /> WELL TESTS Slcvgn <br /> test made? Yes ❑ NO [f If yes by whom? (Krell Driller) <br /> Type of test Pump Cl Bawer❑ Air lift ❑ LAYNE—WESTERN CO. INC. <br /> Depth to water at start of test_.______ft At end of tesL�k NAME P fi or co on) (Typed or printed) <br /> �11 <br /> 15 0 �"°b a�1 ey'�Yafter„hours Water temperature Address analysis rnadeA Yes ( No ❑ If yes, by whom? Canonle a city_ Fontana rCA 71P 9233S <br /> ne log madea Yes © No If%es attach copy to this report License No 452609 nate of this repoRt3 tREV 7 76) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />' 6 <br />