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2 <br /> ORIGINAL STATE OF CALIFORNIA r Do not fl+ll in <br /> THE RESOURCES AGENCY <br />'File with DWR DEPARTMENT OF WATER RESOURCES NQ. 216169 - <br /> Intent No WATER WELL DRILLERS REPORT State Well No <br /> ernut No or Date Other Well No (p � <br />'(1) OWNER Name McCormick & Baxter 12) WELL LOCI Total depth�`[t Depth of completed well1 9 5 t <br /> Address P . O . BQA 1728 from ft to ft Formation (Describe by color character sae or matenal) <br />'City A Zip 9 5 2 01 0- 30 nark Brown Cla�j <br /> (2) LOCATION OF WELL (See mstructzons) <br /> County S L a(iU i n ownee, Wen Wumber — d l e n' ry <br /> Well address if different from above & i i 6 3— 1 0 0 B l u Q r e e `- e n s e clay <br /> Township I I Range Sectio 100- 135 Blue (ne e n <br /> Distance from tinea roads railroads fences etc 135 -159 S a n d\ 'C o a r s e <br />' 1 BlueiiifLrk el - <br /> b - 70 arse\"Sand <br /> -- --170 -1179 B Clay <br /> (3) TYPE OF WORK 1 7 9 --B)7 $ , <br />' New Well 10 Deepening ❑ - <br /> Reconstruction ❑ ♦\ii <br /> Reconditioning ❑ <br />' Horizontal Well ❑ a \— \♦ ��%J <br /> Destruction ❑ (Describe ♦�`� ♦. } l <br /> destruction matenals and> <br /> procedures m Item 12Y <br /> (4) PROPOSED U`S�-` <br />' See Map Attached Domestic <br /> Imgation i ❑ J ♦` <br /> Industrial ti El �r <br /> Test Wel] 0 �— <br /> Stock\\ <br /> Municipa.N C3 <br /> WELL LOCATION SKETCH Other <br /> (s) EQUIPMENT (6) GRAVEL, PACK �} <br /> Rotary 0 Reverse C3Yes 15 Vo ❑ s,, 3 s a n d ' _ <br /> C%ble ❑ Air ❑ Duuneter of bore 1 �t <br /> ♦�` 1 7 9, to\ <br /> Other ❑ Bucket Q Packed From -1_g_7 ft — <br /> (71 CASING INSTALLED '— , (S) PERFORATION8� V — <br /> Steel ❑ Plastic ® Corncrefh ❑' Type of perfoxaiiorror sizcf of screen -Z <br /> From <br /> — <br />' From To Dia Gage or Frame To ti 'Slot <br /> ft ft Wall ft ,� ft \size, <br /> pVC 0 195 <br /> - <br /> (9) WELL SEAL y - <br />'W as surface sanitary seal provided) Yes gl No ❑ If yes, to dep �ft <br /> Were strata sealed against pollution? Yes ❑ No Q Interval — <br /> tiethod of sea Ln Cement & Grout Work staJ- 13 19 Complet <br /> (10) WATER LEVELS WELL DRILL R'S STATEMENT 1' g� <br /> Depth of first water, if Irno ft This weft DV <br /> d d er my risdlction and this report is rrue to the best of mii <br /> Standing level after well compfeth — ft knowledge a efi a <br /> (11) WELL TESTS Slcvm <br /> Was well test made? Yes No If (Well Dn71er) <br /> ❑ F$ yes. by whom? <br /> F=ihnfto <br /> teatPomp ❑ Baler ❑ Air hft ❑ NAMx' D1amon16 —d r e Drilling Inc water at start of test ft At end of test ..... ft (Person. Firm. or corporation) (Typed or printed) <br /> Re__mal/rain after hears Water tempera Add.-10556 P g t U n i a Ln <br /> analysts reside' Yes ❑ *Io ($ If yes, by whom' city-Palo <br /> alectnc Soq made? Yes Q _ do QQ _If Yes attach wpy to tbfs separt License No. S E2 4 0 5 Date of this repo 4-19-89 <br /> owR Ica trtcv 7a1 IF ADDITIONAL SPAGE 35 NEED1=0 USE NEXT CONSECUTIVELY NUMBERED FORM <br />