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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 NO. 252922 <br />' Itt of Intent No <br /> State Will No <br /> +Lal N rmlt No or Date — R R Q Other Well No d <br /> OWNER Nan, (12) WELL LOG Total depth 170 Ft Completed depth-12 5 ft <br /> ►ddress _ from ft to ft Formation (Describe bN color character size or material) <br /> t ety ZIP <br />' (2) LOCATION OF WELL (See mstrtt(Atons) 3 _ 5 <br /> Cotinty S a n J oa r,11 1 n Owners Well Number <br /> Wt 11 address If different from above 15 — <br /> Township' Range 0 G'-1 Section"4DistanLe front utles, roads radroada fences etc Ann , 70 Rlii�= <br />' I IS ' \� <br /> (3) TYPE OF WORK — <br /> New Well [X Deepening ❑ — <br /> Reconstruction ❑ > <br /> Reconditioning ❑ <br /> — n <br /> Horizontal Well ❑ _ <br /> Destruction ❑ (Describe I `rte <br />' destruction materials and pro- L <br /> cedures in Item 12) <br /> (4) PROPOSED US� _ <br /> Domestic <br /> Irrigation <br /> Industrial /\ ❑ _ L <br /> Test Well `` f ' ❑ _ f� <br /> i <br /> Municipal t r ❑ — _ <br /> Other ❑ _ <br /> WELL LOCATION SKETCH (Describe) <br /> (5) EQUIPMENT { GRAVEL PACK S a fl d <br /> Rotary [$ Reverse ❑ IN No ❑ Size <br /> Cable ❑ Air Cl Diameter of bore u <br />' Other ❑ Bucket_ _0 backed from :Z D---_to ft ~ <br /> (7) CASING INSTALLED (8) PERFORATIONS _ <br /> Steel [] Plastic f3I Nnemte ❑ Type of perforation or size of screen <br />' From To 'Diu Gage or From To Slot = <br /> ft ft Iii ' Wall ft' ft` 'size <br /> 0 125 960 105 'h2 .> S c r e e <br /> `f y <br /> (9) WELL SEAL <br /> Was surface sanitary seal provided? Yes [X No ❑ If yes,to depth -70 ft — <br />' Were strata sealedagae/istpollulion? Yes ❑ No ❑ Interval It — <br /> Methodofsealing B ENIONITE Work started 198 Completed 19 <br /> (10) WATER LEVELS WELL DRILLER S STATEMENT <br />' Depth of first water of known ft <br /> Standen level aFterwell completion �� Ft This cell was drilled under my jurisdiction and this report is true to the <br /> S P best of ney knouledae andbthef <br /> (11) WELT. TESTS , <br /> Signed <br /> Was well Iml made? Yee ❑ No X1 If ves by whim? 1Well DrlllerlIr <br /> e of test Pump ❑ Bailer ❑ kir lift ❑ NANIF H F N N I N G S 8 R Q S_ f)R_ILLI N_�_s�L, <br /> h to water at start of test ft At end of test ft ,Person ferns or Lortwration)(Typed or printed) <br /> Discharge gal/min after hours Water temlt+raturr Address 3525 RE I A N f)A I F A V E <br /> a 1k hemteal analysis made? Yes ❑ No X1 If vi s,by whom' City_ M f11=S 1-0, C b 71P_95356 <br /> _ <br /> as elmiric 4 made Yes ❑ No M If vis,attach Lnp,6 to this report L1een%e No 0 Date of this report 1 -988 <br /> OWR 188 IREY 12-88} IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM 96 9635a <br />