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i <br /> STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill in <br /> 3 <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT N0. 361945 <br /> otice of Intent No. State Well No. <br /> Local Permit No. or Date qn—i in Other Well <br /> (1) OWNER: Name P n r t n LLSILLJLto n (12) WELL LOC: Total depth 14 S ft. Completed depth 145 ft. <br /> Address from ft. to ft. Formation(Describe by color,character,size or material) <br /> City . ,zip-q-52 0 — 5 Sand <br /> (2) LOCATION OF WELL (See instructions): 5 — 25 Clay <br /> County Owner's Well Number 25 - 35 Blue Clay <br /> Well address if different from above 2201 WaShjQQtQn 35 39 B l u e Sand <br /> Township o f N_ Range � _ Section 39 = 61 B I u e Clay <br /> Distance from cities, roads, railroads fences,etc. 61 67 Blue S aid <br /> 67 — 108 Blue C1 <br /> 108 114 F rLeA, Blue n <br /> 114 — 119 Caa Blue Sand <br /> (3),TYPE OF WORK: 1 1 9 — 12 5 B I u <br /> New Well tX Deepening ❑ 125 — 14. lueNgand <br /> Reconstruction ❑ 140 — 45 e C l a <br /> Reconditioning ❑ ��r <br /> Horizontal Well ❑ — V <br /> Destruction El (Describe — <br /> destruction materials and pr ) <br /> cedures in Item 12) <br /> (4) PROPOSED US <br /> Domestic <br /> Irrigation <br /> Industrial _❑ ;, _ f`F :�' <br /> Test Well �� ❑ \ V <br /> Munici <br /> WELL LOCATION SKETCH ( �(t�) � 77'— <br /> (5) EQUIPMENT: (N GRAVhL k�CK: S <br /> Rotary)a Reverse ❑ 'Nsml No — <br /> Cable ❑ Air ❑ �l rrrtet of bore tI ``� <br /> Other ❑ Buckets._❑ \ oms 0 t'a <br /> (7) CASING INSTALLED: t ; (B) PERE6RATION& <br /> Steel ❑ Plastic pType of} f on or size <br /> From T D. <br /> Gage or t — <br /> ft. f ifi l Wallt^�� Y size — <br /> 1 — <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yes No ❑ If yes,to depth 50 ft. <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval ft. — <br /> Method of sealing BENT N I T E Work started 19Completed 19— <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water,if known ft <br /> This well was drilled under my jurisdiction and this report is true to the <br /> Standing level after well completion - -- ft. best of my knowled a and belief. <br /> 4 ;^I <br /> L (lI) WELL TESTS: Signed <br /> as w 11 test made? Yes ❑ No [A If yes,by whom? (Weil Driller) <br /> ype of test Pump ❑ Bailer ❑ Airlift ❑ NAME H E N N I N G S B R O S . DRILLING CO . ._ INC <br /> Depth to water at start of test ft. At end of test ft ITL <br /> or co ration)(T or printed) <br /> Discharge gal/min after hours Water temperature Address 3 5 2 5 T E L A€�Q A�F A OF _ <br /> Chemical analysis made? Yes ❑ No lA If yes,by whom? city. M 0 a B S T O a CA ZIP 8 5 3 5 6 <br /> Was electric log made Yes ❑ No (A If yes,attach copy to this report License No. Date of this report- 1 ,-9.9 C <br /> DWR 1n8 1REv. 12-SM IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM tb %355 <br /> E <br />