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' STATE OF CALIFORNIA � Do not f7l in <br /> ORIGINAL <br /> THE RESOURCES AGENCY `� <br /> ' (rile with PWR DEPARTMENT OF WATFR RESOURCES No•2 4 7 6" <br /> ce of Intent ho._ - WATER WELL DRILLERS REPORT State Yell No ,t <br /> Permit No.or Date <br /> f '"'"a 7 rr Other tivcll Z <br /> ' (] WNER: Names._ �(12) Z LOG Tetaldcptb��t Depth aE eompletea wnllt.P 0 Bax 61 2 m k Formntran (Describe by calor, character sire as materistl) <br /> �, Terra Linda Cala f �fp 0 0- To soil <br /> 2-2� Clay <br /> 2) LO TIO OF WELL See lnstructioos) 2 Blue and <br /> Couaty. an JQ$ uin ( Owaels Well Number <br /> Well address if different from o 5-6--73 lay <br /> r�p LL a <br /> nd <br /> Tawnsbip lf - .Ann#a RC]E -fiech <br /> Distance from titles,mads,rsilomds,fences,etc 87-101 <br /> Clay <br /> Mile Nest of Airport -Rd@- 101-11.5 <br /> - 2 <br /> 12 =10 Sancr <br /> (3) TYPE OF WORK 1 0 1 2 NUay <br /> Now Well Z DecpeainR© 1 ine blue sand <br /> ' Rccowmetfon ❑ _ B u a n <br /> Reconditioning 13 e s an <br /> FIorizontal Wel] p an <br /> Destruction 0 (Describe .6223 e ay 0 <br /> destni tion matennls a <br /> procedures In Item .-2 d <br /> (4) PROPOSED 240739 <br /> Blue a <br /> Domestic <br /> ' Yrr1Ra - <br /> Iitdmtrtal O Q <br /> Well Q <br /> ' <br /> to ' <br /> 1- - O <br /> Mun. <br /> {YELL LOCATION 51LL''CCII Other <br /> {5) EQUIPSIkNTi (B) GAA PAM - <br /> ' Rotary ❑ llevene No f5 Size - <br /> Cable Mf❑ ter of bore- NZ- <br /> Other ❑ Bucket ❑ <br /> ' <br /> (T) CASING INSTALLEX\vN1\M- <br /> (8 I1F0 S 1 ouve re <br /> Steel ft Plastic❑ Type of P n o ze of scree <br /> From P Ditt dh r FFo TO <br /> ft. f in Win f ft si <br /> ' 25 © 259C2 <br /> ' (s) WELL SEAL �t <br /> Was surface sanitary seat provided? Yes 11 No Q It yes, to degth_a-,--_ft <br /> Warn strata sealedmt1 pollution? Yes [3No 0 Into rv-I tt <br /> Methad of se 1 Work start 8 Completed 111 <br /> ' (10) WATER LEVELSt WELL DRILLEWS STATEMENT <br /> Depth of first %vator, If knoirn_�_ - �fk This well um dr7kd tinder tnp furbetictfon and this report is true to the best of MY <br /> Standingg 10 37.mknotoledge and belief a <br /> II V V,41 <br /> (11) WELL TESTS Stavxo� ' <br /> ' Was %veil test made? Yes No ❑ If yes, by whom? P GIVE, <br /> (Nell Duller) <br /> Typo of testPumpg Bailer[3Air lift❑ NAME Henn% �;s Bros,, DrilliLagg C <br /> Depth to water at start of tis 2 R At end of test ft (Penon $rm,or corporation) (Typed or printed) <br /> 180 al/� t ours Water temperate Addmz 2 �e�andale <br /> Df.�,ar�a..-�--R Modesto Calif <br /> ' Chemical analysis made? Yes O No f$ If yes, by whom? City <br /> Inst mad-? Ya O Ne If yes, AS v 53.50 <br /> attach copy to this report racense No. 290 1 _Date of this report 6"15`f <br /> tee ttt>ty s vel IF Af]DITIONAE.SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM esslsaso r-7e sure QUAY Ot r o■F <br />