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W KICHNAL STATE OF CALIFORNIA DO not FIZZ 177 <br /> THE RESOURCES AGENCY n� <br /> IFile with DWR DEPARTMENT OF WATER RESOURCES NO. 47979 <br /> \ntjce of Intent No WATER WELL DRILLERS REPORT Stite Well No <br /> Loci! Permit No or L) 77_505W,_ "7 <br /> Other Well o=.F <br /> \ <br /> 1 OWNER \,17e (12) WELL LOG2 2Q <br /> �T .t Total depth ft Depth of completed well 212 ft <br /> less 00 1Y • Ri on Rd • from ft to ft Formlhnn (Descnbe by color character size or mgtend) <br /> Cit% Ri ori CA . zip 66 0 - 21 Sand <br /> (2) LOCATION OF WELL (Ste instructions) 21 — 2 Clay <br /> Counts n J Oii ner. Well Number 25 - Sand <br />'Well iddress if different from ibovc 32 — Clay <br /> Tun n5hrp R2ni-e SeLtin 3 8 Sand <br /> DI%t IuLe from cities roids riilrnids fences etc 14 Wash]., to t - 10 Clay <br /> Ripon. 10 - 108 Sand <br /> - 11 <br /> Clay <br /> - 1 Sand <br /> (3) TYPE OF WORD —102 C a <br />' \e%% 1%ell X Deepening; ❑ - Sand <br /> Reconstruction ❑ 169 _ ]_ 2 r-tld <br /> Reconditioning; ❑ Nlb2 - ld5 Sand <br />' Horizontal 1t ell ❑ - 195 <br /> 19 ` ' Clay <br /> Destruction ❑ (Describe \ ` Sand <br /> destruc4nn m itenlls and \ <br /> procedures in Item 12) 209 — Clay <br />' (4) PROPOSED USE <br /> Domestic <br /> Irngition ❑ 1 _ <br /> Industri it ❑ <br />' Test Will ❑ _ <br /> Stock C1 f _ <br /> Municipal ❑In — r <br /> WELL LOCATION SKETCH Other ❑ _ <br /> IV EQUIPMENT (6) GRAVEL PACK \y _ '�j <br /> Rotary 29 Reverse [] Yes [$ \To ❑ <br />�Cible C] Air E] Diameter of bore pit <br /> ther ❑ Bucket ❑ Packed from_ d 2 tai___2l2 �ft <br /> (7) CASING INSTALLED (8) PERFORATIONS hand cut — <br /> Steel Q Plastic Concrete ❑ Type of perforation or size of screen — <br /> From To Dia Gage or From To Slot - <br /> ft ft in Wall ft ft size _ <br /> 0 212 1 OW193 212 - <br /> (9) WELL SEAL yy - <br /> Was surface sanitary seal provided' Yes No ❑ If %es to dept 5-0t ft = <br /> Were strata sealed lgamst pollution' Yes C] No ❑ Intervtil—ft <br /> Method of seahn. Bent Work started 00 19= Completed 19 <br /> (10) WATER LEVELS WELL DRILLERS STATEIN9ENT <br /> IDepth of first water if kno%vn— —ft This cell mas drilled under my rurisdwoon and this report is true ro the best of my <br /> St-inding le%el 'after hell completio ft knowledge an belief <br /> (11) WELL TESTS SIG-,E- 3 C <br /> \N as well test rat ide' Yes C] \o n if ves by whom? (N ell Driller) <br /> F <br /> ype <br /> of test Pump L� Rgiler 0 Air lift ❑❑ NAME— <br /> o <br /> Ings Bros. Drilling Co. , Inc. _ <br /> epth to nater it st in of test ft At end of test ft ( rs firm or orpnr tion) (Typed or printed) <br /> Discharge Address 3 52 5 Tela nda e v e • <br /> gal/nun after-------hours Nater temperatu[e A <br /> hemical �inatvsis ni�ide' Yes ❑ No 9 If ves by whom? City8 e S O, CA. Zip F 350 <br /> a.tnc log made' les ❑ No EX If%es attach cop% to this report License \o 2901913 Date of this repo <br /> Dwft 188 (REV 7 76) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVE=LY NUMBERED FORM creta 9607 7650M QUADOr CSP <br /> y 1� <br />