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' ORIGINAL STATE OF CALIFORNIA Do not fill Ili <br /> THE RESOURCES AGENCY <br /> File with DWR DEPARTMENT OF WATER RESOURCES No, 0 9 7 92, 0 <br /> e of Intent No WATER WELL DRILLERS REPORT <br /> Pernvt No or Dn[e State Well \o <br /> Other WellNo ��C��1 C?i, <br /> } OWNER N ime (12) WELL LOG 12 5 �jC <br /> � Tnt�]depth Depth of completed well 1eJft <br /> Address.. 2317 S N from ft to ft Formation (Describe bs color (MrIcter +ize or mverml) <br /> Ca) ``• Q5366 - )and <br /> Lip � <br /> t (2) LOCATION OF WELL (See imtrtictions) _ Hardpan <br /> Counh -`iiia ui OO+sner s �tiell 'dumber LD C ay <br /> dell address if difterent from above — 16 Qland <br /> Tmi nshrp R1nRe Setum ay <br />' Distance from cities roads rnilrnlds fences, etc- 23 8 Q• hila 22 4? Sand <br /> — <br /> 49 rid <br /> 57 W—Crave! <br /> �L (3) TYPE OF WORK - <br /> �1 1 <br /> het. We11y1 Deepening ❑' _Reconstruction ❑ <br /> a Reconditioning 11 96 — <br /> 1. <br /> Horizontal NN ell ❑ <br /> Destruction ❑ (Describe <br />' L✓�(lY I�( t destruction in itenals and <br /> kk procedures rn Item 12) prcmeir�y wel 1 .-c_QyerS t l A <br /> JG1 (4) PROPOSED USEtlTis-- w -11 andam not res ons able <br /> or AM <br /> ++ �P-til,� �t Domestic Ex YL e z o removing of the <br /> .J _ IrriKatinn ❑ seal —ora s i <br /> Industrial ❑ <br /> Test Well Cl <br /> K! Stock (] <br /> Municipal ❑ — <br /> WELL LOCATION SKETCH Other ❑ <br /> EQUIPMENT (B) GRAVEL PACK <br /> 11,31 <br /> Rot-Iry ] Reverse ❑ Yes g] No ❑ Size ea <br /> C thle ❑ Air It <br /> ❑ Diameter of bum — <br /> Other Q Bucket ❑ Packed from-5-CL-ti) 195 ft <br /> (7) CASING INSTALLED (8) PERFpO1�,ATION _ <br /> CZItIsteel ❑ Plastic 5ot1W <br /> $] Concrete ❑ T%pe of perforation or size of screen <br /> From To Dia Gage or From To Slot _ <br /> ft ft in Wall ft ft s ze _ <br /> 125 —6--160P-VC q n 1 - <br /> (9) WELL SEAL _ _ <br /> Was Sin face sanitary seal provided' Yes fat No ❑ If Yes to depth-ft 0 ft <br /> Were strata sealed against pollution" Yeses ❑ No Ek Interval _ ft — <br /> �fethod of seahn Cement \Mork started 19 Comple 19 <br /> (10) WATER LEVELS WELL DRILLERS STAT b4E <br /> Depth of first water if knoll ft This icel! was d under <br /> Auris r ran a t report is true to the bent of my <br /> Standing ]es el nFter well w+mpleho ft 1 nou IedKe b <br /> 11) WELL TESTS SIGNED <br /> Vas well test made' Yes ❑ No � If yes by %%hom" (Well. Drille ) <br /> Tvpe of test Pump ❑ Bailer ❑ Air lift ❑ NAME Panero Well l�ril In _ • Inc. <br /> Depth to slater it start of test Et At end of test Et' '�14s�ers�t,�rn�u�inr�Li�r6 6Ty�r�&mted)D—harge gal/mm after_ hours Water temperjttue Address r� G <br /> cal anahsis made? Yes E] No ❑ If Nes by whom 11 cit, _Oakdale, Calif . Zip 95361 <br /> s electric lot; made' Yes ❑ No [] If+es attich copy to this report License No 333114 Date of this report 11123 Z SO 1 <br /> R 188 (RrV 7 76) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />' 10 <br />