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STATE OF CALIFORNIA <br /> ORIGINAI THE RESOURCES AGENCY Do not fill in <br /> File with DWR (A=PARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT N0. 290910 <br /> P-tice of Intent No State Well No <br /> OL-dl Permit No or Date Other Well No <br /> (1) OWNER Name (12) WELL LOG Tottl dtpth .�ft Completed depth.2A-_ft <br /> lddress From ft In ft Formation (Describe b% color character size or material) <br /> City _ ZIP _ <br /> (2) LOCATION OF WELL. (See instructions) e <br /> County Owners Weil Number — <br /> Well address if different from above <br /> Y <br /> Township Z e RangSection — <br /> Distance from cities, roads railroads, fences, etc <br /> n <br /> _ n <br /> (3) TYPE OF WORK — <br /> �,a .,� � New Well X Deepening ❑ — <br /> Reconstruction ❑ — <br /> Reconditionmg ❑ <br /> Mw-3Horizontal Well ❑ �� \ � <br /> 0 N Destruction ❑ (Describe <br /> destruction materials and pro- <br /> n �\ <br /> ic cedures in (tern I2) ` r� <br /> #x+�idi <br /> y (4) PROPOSED US _ n <br /> OL <br /> Domestic <br /> Irrigation , <br /> {Qn� Industrial ❑ \� �` N t <br /> Test Well \ 1 ❑ C� �� �� <br /> Munici . \ U <br /> WELL LOCATION SKETCH ibe) <br /> f <br /> t5) EQLIPMENT P Cn — <br /> �`? <br /> Rotary [I Reverse ❑ ` No <br /> Cable C] Air ❑ etof bore <br /> Other 91 Bucket_ . c d ram <br /> (7) CASING INSTALLED 44 \ (8) PERPeRATIONS <br /> Steel ❑ Plastic 5 riczete Ty of fo on ur size ofJSei _ <br /> From T 14 Gage or tri T � dt — <br /> ft ft\' In Wall -fib— t" 'size <br /> (g} WELL SEAL v Was surface sanitary seal provided? Yes X No ❑ If ves to depth ft <br /> Were strain wnled-tgainst pollution? Yes JQ No ❑ Interval 0 it — <br /> Method of seating Ze4Zat DE Worl,started 1913B cornpl( 57 19-85 <br /> (10) W-YTER LEVELS �j WFLI DRILLE S STATEMENT <br /> Depth of first water if known ti/ ft. <br /> 5_... • I'hts well tuns tiled under my jurrsdic[ion and tthisreyur[ Is [rue to the <br /> 5taading level after well completion h y of hes of mrtgc and bc!et <br /> (11) WELL TES I'S Signed <br /> �Was well test made? Yes [I No 4j4 If ves by whom? (Well Driller) <br /> spt.oftest Pump ❑ Bailer E] ler lilt ❑ `14II SPECTRUM EXARATION, INC <br /> i cpth a xatcr at tart of test Ft 4t end of test it (Person.hart or corporation)(Typed or printed] <br /> Dia nerve 14AIIiuinAfter h.urs Vater temperature Addrpts 2825 E MYRTLE STREET <br /> C lu mical arialvsis made? Yes ❑ No ❑ If ves by whom? Gity STOCRTON CA zip 95205 <br /> Was electric log made Yes ❑ No ❑ if ves attach copy to this rerinrt License No 512268 Date of This report <br /> t7wpt I us (REV 12 Bel IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NumsERED FORM ss 94353 <br />