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STATE OF CALIFORNIA <br /> oR1C7l�A�, THE RESOURCES AGENCY Do not fill to <br /> File with SWR DEPARTMENT OF WATER RESOURCES 290909 <br /> WATER WELL DRILLERS REPORT No. <br /> Mice of Intent No <br /> 1 State Will No <br /> 1 neat Permit No or D �.Q�J <br /> ate� Other Well No <br /> r725QJ� <br /> (1) OWNER Name e (12) WELL LOC Total depth +' ft Completed depth 2&.T ft <br /> lddr(ss from tt to It Formation (L)escrtbe by color character size or material) <br /> City =144 LIP <br /> (2) LOCATION OF WELL (See Instructions) — <br /> Courtty Owner s Well Number — — <br /> Well address if different frnm above — <br /> Township S Range SF Section — <br /> Dt.t-ince from cities roads railroads, Fences etc <br /> (3) TYPE OF WORK _ <br /> New Well liK Deepening ❑ <br /> Reconstruction ❑ _ <br /> Reconditioning © ^ n ? <br /> -ll Horizontal Well ❑ / <br /> 4k) 1 Destruction El (Describe r1 <br /> ; destruction materials and pro- <br /> Q� cedures in Item !z) <br /> MYv~l (4) PROPOSED USES J �. �✓ <br /> O Domestic <br /> Irrigation <br /> • (;,. Industrial <br /> Test Well \ ❑ <br /> blunicipa <br /> WELL LOCATION SKETCH <br /> 15) EQUIPMENT �63 RACK <br /> Rotary El Reverse ❑ yt* X NO��`E! <br /> Cahle ❑ Air Elmetes of bore <br /> Other $I Bveket� [a \cued from \to 3a F <br /> I5 5 <br /> (') CkSl-,C INSTALLED t (8) PERFO_ft\TIONS ^ _ <br /> Steel ❑ Plasticl ori�TWe Cl TvpeofIn )uon or size of sfr 4xi ' ' _ <br /> � r <br /> ;From �o D Gtge or <br /> ip Wal] �t size <br /> - <br /> t9) WELL 5E'iL — <br /> Was surface sanitary seal provided? Yes 19 No ❑ If yes,to depth -3, ft — <br /> Were strata sealed against pollutions Yes K No Intervals J® it <br /> 4l et hod oisealing Work started 19 Completed ly <br /> (10) 1V-�TER LEVELS WE'LL, DRILLERS ST 1 I EMENT <br /> Depth of first water if l nuwn [ — It <br /> Thrs u,ef! if, 11Pd under nuf 1r,risrYc rm and this report a true to the <br /> Standing level after wellcomplelinn It best of na nv fuloc cine L,Iic <br /> (11) WELL TESTS 5i ned �- <br /> Was well test made" Y h ❑ No If yes,by whomP iWe.lI Drdicr) <br /> '�}pc of test Pump Balser ❑ Air lift ❑ 14ANIE SPECTRUM E RATION, INC <br /> cpth to water at start of test it it end of test It (Persue rimi r wriwrauon};Toped or printedI <br /> IhscharKe eai/mmafter hours Watcrlernperaturt {dClrMs 2825 I; MYRTLE STREET <br /> Cliemicalanalysismade' Yrs U No ❑ if ses by whurn� C,tv STOCKTON CA LIp 952U.. <br /> Was electric log made Yrs Q No ❑ If yes,attach copy to this report License No 512268 Date of this report <br /> owR Ise(REV 12-ee1 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM e6 96156 <br />