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STATE OF CALIFORNIA <br />' ORIGINAL THE RESOURCES AGENCY Do not fill to <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> t <br /> WATER WELL DRILLERS REPORT NO. 252899 <br />' 'ce of Intent No. L OA1 De A - EN rS* State Well No. a�r S OSE�.4-� <br /> a]Permit No. or Date—88- 12 �r TTA' �y R �, Other Well No. <br /> (1) OWNER: Name (12).WELL LOG: Total depth 39 5 ft. Completed depth 387 _ It. <br />' Address 44CCA e <br /> from ft. to ft. Formation (Describe by color, character, size or material) <br /> City zip <br /> (2) LOCATION OF WELL (See instructions): - <br />' County San jnaQUin Owner's Well Number 15 _ <br /> Well address if different from above <br /> Township Q�S Range OSe: Section 4 <br />' Distance from cities, roads,railroads,fences, etc. - <br /> 94 <br /> !1 <br /> 94 15; ClAv <br /> 1 5%5 <br /> h <br />' (3) TYPE OF WORK: T <br /> New Weli )C( Deepening ❑ <br /> Reconstruction ❑ <br />' Reconditioning ❑ <br /> Horizontal Well ❑ r <br /> Destruction ❑ (Describe <br /> destruction materials and pro- <br /> ` `J <br />' cedures in Item 12) <br /> (4) PROPOSED US <br /> Domestic — ��� \�i I �� t1•'•. <br /> Irrigation <br /> Industrial <br /> \ ` <br /> Test Well ❑ �, �r LTi `� <br /> Other U B L I C vu <br /> WELL LOCATION SKETCH ( >be) <br /> ,1, . ,. <br /> (S) EQUIPMENT: A"GRAVALR�CK: arTd-, & <br /> Rotary� Reverse ❑ Nd`d Siio� <br /> Cable ❑ Air ❑ <br /> Other ❑ Suckey� �c{;ed from _1[10 <br /> (7) CASING INSTALLED: t ` I y (B) PEKFORATIC kM: <br /> steel ❑ tic�Plas �reCe Tyr�of fo''on or size <br /> From D'3- Cage or <br /> _ of - <br /> ft fI1+"� fWj Wall �� r%4: ✓size <br /> to 36-7 <br /> (9) WELL SEAL: <br /> Was surface sanitary sea{provided? Yes E( No ❑ if yes to depth In D- ft. <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval ft. — <br /> !Method of sealing CFMFNT Work started- 1 A n�L 19.$-. Completed 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEtifENT: <br /> Depth of first water,if known ft. This <br /> Standing level after well completion - ft. lest f oily krpwledCd under e and belie] jurisdiction and this re .;,rt is true to the <br /> (11) WELL TESTS: Signed <br /> as well test made? Yes ❑ No EX If yes,by whom? (Well Driller) <br /> pe of test Pump Cl Hailer ❑ Air lift ❑ NAME <br /> I th to water at start of test ft. At end of test ft. (Person, corporation)(Ty or printed)- ^— <br /> —harge gal/min after hours Water temperature Address j r.2 q ' PEC—A—D rI—E A V E= . <br /> _Q ;,I IS _ <br /> Chemica{analysis made? Yes ❑ No � If yes,by whom? City ZIP F E g 6� _ 1 Q <br /> Was electric i made Yes 2q081 A Date of this report 8 e <br /> og ❑ No If yes,attach copy to this report License No. <br /> DVHR 188(REV. 12-661 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br /> 86 96355 <br />