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' 1 & cI� rst..c4y-S <br /> STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill in <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> . WATER WELL DRILLERS REPORT N0. 316681 <br /> i otice of Intent No State Well No <br /> Local Permit No or Date — Other Well No OVIC-ttra <br /> (1) OWNER Name Moorman1 (12) WELL LOG Total dLpth -52E ft Compktrddtpth ft <br /> cfrom ft to ft Formation (Describe by color character size or material) <br /> Cityity ZIP <br /> (`?) LOCATION OF WELL (See instructions) — <br /> County San loaquin Owner s Well Number <br /> Well address If different from above — <br /> Township Range_f—` '`�" Section Distance from from cities roads,railroads, fences,etc — <br /> (3) TYPE OF WORK — <br /> New Well ❑ Deepening ❑ — <br /> Reconstruction ©Reconditioning El <br /> ❑ <br /> Horizontal Well ❑ <br /> Destruction)9 (Describe — <br /> �. <br /> destruction materials and pro- <br /> cedures In Item 12) <br /> (4) PROPOSED USFI;1 <br /> Domestic <br /> Irrigation Q '� <br /> Industrial ���\ ❑ i� _ <br /> Test Well <br /> Munict <br /> > \"/ ❑ _ <br /> OAer _ ^ <br /> µELL LOCATION SKETCH <br /> (5) EQUIPMENT GRAVELRACK ' — — <br /> Rotary ❑ Reverse ❑ Y)es'© No❑ Size <br /> Cable ❑ Air ❑ m�#ro <br /> etev of bore <br /> Other El Bucket-0 Facked m to ft, <br /> S71 CASING INSTALLED- 1 ; (S) PERF84kkTIONS _ <br /> Steel ❑ Plastic ❑ aitixe Tv of r onaLon ovr srze ai 0 — <br /> From n I Gage or 9!! T�o��� <br /> ft fel to t Wall <br /> (9) WELL SEAL — <br /> Was surface sanitary seal provided? Yes ❑ No ❑ If Yes,to depth ft — <br /> Were strata scaled against pollution? Yes ❑ No ❑ Interval ft. — <br /> Method of sealing Wnrk started 19&2 Completed I ILI <br /> (10) W-kTER LEVELS WELL DRILLERS ST-kTE.\,iELT <br /> Depth of first water if known {t <br /> Standing level after writ completion ft Thu tceu etas drilled Cr my Ju tctlon and this report is true to the <br /> best of my lrtioteltr d heltFf <br /> 11) WELL TESTS Sten <br /> well test made Yes ❑ No ❑ If ves,by wlumi? Drill <br /> pe of test Pump ❑ Bailer ❑ Air lift ❑ TAME t <br /> dth to water at start of test ft 1t end of test It (P n,firm,or carpo on)(Typed or printed) <br /> —ucharge gal/min after hours Water temperature Add,,,,, <br /> C.hemicalanalvstsmade? Yrs ❑ NozIpg57f15 <br /> ❑ If ves,by whom Clty <br /> Was electric UK made Yes ❑ No ❑ If vm attach copv to this report License Nn Date of this report <br /> DwR 188 MLEV l2i.8al IF ADDITIONAL SPACE! IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM 96 96"s <br />