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..,�� STATE OF CALIFORNIA Do not fill in
<br /> _ THE RESOURCES AGENCY
<br /> He with DWR DEPARTMENT OF WATER RESOURCES ... No, 36138
<br /> ,,,ti,e of Intent N,,. WATER WELL DRILLERS REPORT State Well No.
<br /> soca! Permit No. or Date Other Well No.
<br /> I ; OWNER: Name (12) WELL LOG: Tota]depth ft. Depth of completed well ft.
<br /> ,ddress 2114 Fullerton froom ft. to ft. Formation (Describe by ei)lor, character, size or material)
<br /> t>_ Stkn. Ca. zip psoii
<br /> 2) LOCATION OF WELL (See instructions): Glay
<br /> ."Amt, San Joaquin O,vner's ]fell Number 13 garIA
<br /> 1�i1 odd n•ss i( d111crent crow above — 40
<br /> ,.nship Range Section_ 40 4
<br /> '.sand IV
<br /> iuLuuc fr,nn cities, roads, railroads, lenc•es, etc — 50 `
<br /> 50 - 54
<br /> 54 - 62.,\ sand
<br /> 62 - 90 cla
<br /> (3) TYPE OF WORK: 9p0 � 98 sand ravel
<br /> Ne„ \\'ell} , Deepening C] 98 05 clay
<br /> Reconstruction ❑ 105 1- q C 0X, sand
<br /> 1�1
<br /> Reconditioninyt ❑
<br /> JI—ivwtal Well ❑ —126 sand
<br /> Destmm,m G (Describe `,\. ) y
<br /> do,tm,tion materials
<br /> p2wedures in Item � - \-�-san , ,,gr•avp.
<br /> (4) PROPOSED�;SL�r, �-. San a y
<br /> �� v\
<br /> D,nnrStie y)
<br /> Irrigatom, "N
<br /> ❑
<br /> MuniciNl-,
<br /> WEI-1, LOCATION SKETCH \ \ Other ❑ 77�
<br /> i) EQI IPSIENT: (6) GRAVEL, PACK: —
<br /> hotary ` Bever- ❑ Y4�, ❑ Nn� Stze —
<br /> ;J
<br /> C"I lc C Air ❑`-\ 1)i&rwter of bore \. .
<br /> UtFarr ❑ Ruck et Talk edrf rum ..W----- _L
<br /> .-) CASING INSTALLED; _ h 1'PERFORATIQNS: —
<br /> m".1 ❑ Plastic ❑ Cryn^4�ete [ T\1,e of perforaltr\ or yl n-of screen,. ,
<br /> hruul hn Dia. Ga�Leor From, To Slot�J
<br /> ft. ft.. in. \Vail ft. J ft. size' -
<br /> w -
<br /> 1 9) WELL SEAL: -
<br /> \t'a, surface sanit., - seal pro,'idedY ]es ❑ No ❑ if s-rs, to depth ft. —
<br /> \fere strata •a-Alyd avainat Yes ❑ No C„ lnter,al ft. —
<br /> iletfe,d of sealiwl W—k started 19 Completed 19
<br /> 10) NVATER LEVELS: \TELL DRILLER'S STATE.\1ENT:
<br /> Depth of first ,cater, if knmcrt tt. This well was drilled unda'r my iurisdictiun and this report is tnw to the best of my
<br /> �taudinC level .11trr „rll cooilrlc•ti-m
<br /> 1t. knowledge and bcluj.
<br /> 11) \\'ELL TESTS: S1CNED
<br /> 11"as ,cell test ,, dr? ]'es �. No C: if ,es, hV- „hone° (]Yell Driller)
<br /> Tvpe of test Pump ❑ Bailer ❑ Air lift ❑ NA\IE-Waw
<br /> Depth to „atR'r st start of test ft. At end of test ft �r cpu rpo,atiun t )p ur rn ea)
<br /> Discharge ❑al nein afterh-.rs \\ater temperature Address P-0 a Ox 900
<br /> Ch""i'A :amd ctv Stkn. zit, 95201
<br /> .u niadeP ]'rs ❑ Nu ❑ ]1 yrs, by ,Thom'
<br /> '-,ti, 4.e made? Yes ❑ No [ 1f yes, Attach ,11111 to this report I License No. 2nn794 Date of this rct>i�
<br /> 18e IREV 7.76, IF ADDITIONAL SPACE 15 NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM 43B16-50 QUAD(DT 05P
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