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,vAL 5rATEOFCALIFORNIA Do not fill in <br /> File witFilDVIlR <br /> THE RESOURCES AGENCY' p� <br /> DEPARTMENT OF'WATER' RESOURCES No. 36138 <br /> Notice of Intent No. WATER WELL DRILLERS REPORT � <br /> State well No. <br /> -Local Permit No. or Date <br /> Other%yell No.A_ <br /> oN NER:: N,,ine_1,ee--Mc" -Dan la1d (12) WELL LOG: Total depth_ .__._ft. DePih.nE completed ne1L.___ft. k <br /> frnn[ ft_ to ft. Forn-mtion (Describe by color, character, size nr material) ' <br /> (2) LOCATION OF WrLL (sEe insLrtrctiol�s): — � <br /> ConntY_._ San JO_ C'ux,n Osctser's 1FeiL Acuuher - __ '_ - <br /> aa d <br /> L5'e11 address if different from above— <br /> - <br /> �7��,�nshiP_.- _. I;am•c Section 4� 4 5 —.Clayi <br /> Distance irom cities, roads, railmarls, ienees,etc. - - <br /> 50 54 <br /> - cla <br /> 54 62--, sand-. <br /> 62 - 90 clay <br /> (3) TYPE OF NVORK: 90 => 98 sand grave3 <br /> New Welll`] 17eeper:ink ❑ 98 -3.05 <br /> clayI <br /> Rccnnstnrction <br /> o . J_05 1:IClaZ, sand <br /> -]_l8 y,- <br /> - Reconditioning ��a_, <br /> fforizonta: c11 ❑ 8\ -J-26 a nd i <br /> lles2 nactiorr ;_] (Desc rite _6". y� 3� - \`C -ay - <br /> destruction nua2erials and •,•`• _ <br /> procedures in Ilem 12) - '-'San , .-grave <br /> (4) PEOPOSED USE.,. sandy C. ay I <br /> 17omestic xx'> <br /> Irrit;atiun ❑ - ,_ . <br /> ]ndustri;t! ❑ <br /> Test Well ❑ ``.J -_ - - <br /> _ t <br /> Wil.f-L LOCATION SKETCH Other "' ❑ �� "� <br /> (G) GRAVEL PACK: <br /> Rotan' Reverse ❑ Yes ❑ Size <br /> :able f] Air [] Diarneter of bore <br /> ` 1 <br /> )thea ❑� Rocket Q Pac•ked.from <br /> J7) CA5INC:INSTALLED:-. (S) PERFORATIONS; <br /> - I <br /> L'Ztevj ❑ Plastic Concrete Q T.-I>e of perforation or size of sereeu <br /> From, To Dia. Gage or Frain �ft- <br /> Slot _`.. <br /> ft. ft. 2n, �j all ft. size _ <br /> _�— ------ <br /> P <br /> --vc - <br /> 5 tt --s - <br /> (9) WELL SEAL: <br /> U'ls <br /> surface sanihrr}- seal provided? Yes ❑ No ElIf yes, to depth ft. - <br /> re strata sc.[led e;;ainst laallution? Yes ❑ No 0 Inlen-al <br /> Method of sealim, <br /> - - -- Rork started_ 19 -CampIcied 19 <br /> 110) ��'ATER LEVELS: WELL DRILLEWS STATE�IE\T: 1 <br /> . Icpth of {first �Yatcrif kuo%Yrt ft. <br /> This teelI was drilled under my jurisdiction and this report is true to rhe best of my <br /> tandin•_ level after ,yell completion g knowledge and belief. <br /> (11) WELL TESTS: � SICNIED <br /> Was u-eil test made? Yes C• No ❑i If .cs, by whom'? (�tirell Driller) <br /> L:�-,, <br /> ftest' Pump [❑ Railer ❑ .lir lift ❑ I�AXfE_yy� .� �.13'�c---pr.� f�h to water at start of test ft. At end of test ft { e.-. Aunt,or arrporation) (�1 <br /> Discharve Valrmin after hours Cater temperature Address P•0 e box 908 <br /> S�kn. 95201 <br /> Lw'mival analysis made? 1'es i No ❑ 1E yes, by tvhnm? Ciry Lip <br /> •cmc log mode' Yes ❑ Kn ❑ If Yes, attach copy to this report License No <br /> —2-07g,%�� _Date of this reparL _ �] <br /> -Bd [REV. 7.761 IF ADDITIONAL_ SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM 13016.950 1.70 SO.QUAD OT OSP <br /> F' <br /> J <br />