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STATE OF CALIFORNIA <br /> ORIGINAI. THE RESOURCES AGENCY `p Do not fill in <br /> Fife with DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPOiRT N0. 252838 <br /> t otice of Intent No. State Well No. <br /> Local Permit No. or Date 87-349814397 Other Well No.OT A�C <br /> C <br /> (1) OWNER: Name San Jna qij i n Cn Rangers (12) WELLI LOG: Total depth2.47 'ft. Completed depth 22 ft. <br /> Address 1290 S h d W R d . Club from ft, to,, ft. Formation(Describe by color, character. size or material) <br /> city Stnrktnn . -Ca—zip 9520 <br /> eisyctios1 0 - R3 To Sail <br /> (2) LOMR% WEtjjnftutin ) <br /> 3 -`! 1 9 Clay <br /> County S a fl J 0 a q ,1 in Owner's Well Number 'I <br /> `, <br /> Well address if different from above 2(2 6 — 1 Fj �—'1-4$ Sand <br /> C 1 a a & S c <br /> Township Range Section <br /> Distance from cities, roads, railroads, fences,etc. —11 -e <br /> — Iq CiA <br /> k h'\;a <br /> 89 92 S a n aL-1 <br /> (3) TYPE OF WORK: <br /> New Well [X Deepening ❑ —'I <br /> Ill...rrr Reconstruction ❑ 'i i� <br /> Reconditioning ❑ p <br /> Horizontal Well ❑ p ! <br /> Destruction ❑ (Describe <br /> destruction materials and pro- "0 2 1 <br /> cedures in Item 12) _2 � IS k k <br /> r (4) PROPOSED US — E �' — r v,• <br /> L Domestic —gip�.2M2 =`0 <br /> E� <br /> Irrigation V/ ,'.p <br /> Industrial < © < ; ; <br /> Test Well \� ❑ �. ?"'`i <br /> Municipal \ J © <br /> WELL. LOCATION SKETCH �6e) �/ ^ \'. <br /> (5) EQUIPMENT: V,GRAVtL PACK: S an di."`` <br /> r � <br /> Rotary Reverse ❑ �e N'n'� /,Stz — Z <br /> { <br /> Cable ❑ Air ❑ 'F�'�rtete'r.,of bore — I <br /> Other ❑ Buckey.Q P�d�dfrom 1.iln te�!�` <br /> 17) CASING INSTALLED, t 1 (8) PERFORATIONS: _ <br /> Steel ❑ Plas[ic [ nc'tet� Ty of Foi anon or size of <br /> From T ik Gage or <br /> ft. fr; ` i1p.' Wall •Vsize <br /> •``J —E <br /> (9) WELL SEAL. <br /> Was surface sanitary seal provided? Yes)l No ❑ if yes to depth 1 Q G ft. <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval ft. —' <br /> Method of sealing RENTONITE Wort:started S p tI17 19 Completed 19— <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water,if known ft <br /> This well u.�as�drilled under rriy jurisdiction and this report is true to the <br /> Standing level after well Et }nest of my knowledd and belief. ; 1 <br /> (11) WELL TESTS: Signed _ IZ!,4Q _. -. )� <br /> Was well test made? Yes Cl No IX If yet by whom? I (Well Driller) <br /> Type of test Pump ❑ Hailer ❑ .Airlift ❑ NAME <br /> n si {person irra or ro ra ton v or nn U s I PIC <br /> � p1h to wafer at start nF test ft. At end of test— ft. � P <br /> NDAIF AVE <br /> ischarge gal/min after hours Water temperature Address t�,,,tt�r .� r <br /> Chemica]analysis made? Yes ❑ No CC IE yes,by whom? City?0 nyy E S TQ� - C-A ZIP <br /> Was electric log made Yes ❑ No X If yes,attach copy to this report License Nu. . Date of this report 7 8! <br /> AWR 188(REV. 12-86I IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM -- 86 46133 <br /> � Q <br /> Ir <br /> f � <br />