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ORIGINAL STATE OF CALIFORNIA °',k _ Do not fill 911 <br /> THE RESOURCES AGENCY <br /> DEPARTMENT OF W <br /> Fi��with �wR SOUNo. 097909 <br /> } <br /> �3WATER Rf~ I4CES 1 <br /> � <br /> WATER WELL DR LLERS''REPORT e of Intent Nn. , <br /> Slate Well No. <br /> p <br /> Permit No.or Dat Other Well NoO�.�i <br /> ' 21 <br /> i <br /> Adrlreds 3373 S WilTf) - from it. to. ft, Formation (Describe by color, character, sire or tnaterinl) <br /> City umn. 9'5366 an <br /> (2) LOCATION,, OF WELL (see instructions), a r pari <br /> County!can -r� lain Owner's Well Number ay <br /> Wall address iF diilorent From above <br /> an <br /> ' 18 22 V a <br /> Towniblp llnnro Secti — ay <br /> Distance from cities.mads,railroads lances,etc Z'3 • :Llma <br /> — <br /> U0 -sand <br /> 49 <br /> k <br /> ` blc+v Well Deepening❑ < -611.1"nitt sand <br /> Recoru tructfon <br /> Reconditioning p <br /> 'Horizontal Well ❑ <br /> Destruction p (Describe <br /> s BQ destruction materials a <br /> y procedures in Itera 1 A, stalled <br /> 114, (4) BFWFOSED'U oC es <br /> .� uifra � Domestic NCR F�Ii1UY�Yl of the <br /> 1 Inlgntion a Ca8'n <br /> � ••Y Industrial � Q ' <br /> r` * Well Q <br /> 44 <br />. ��++rro� L4rF'�j��'� IYEunieip'rl <br /> WELL LOCATION SKETCH 4& 0 <br /> (5) EQUIPMENT: (s) CRA PACKS v <br /> Rotary TO Reverse p $i N, <br /> Cable Il <br /> ❑ Air ❑ i er of bore <br /> ti <br /> Other © Bucket ❑ -- <br /> {7) CetSING INSTALLID (8) PERF RAS $s <br /> Steel P1ast{c A�iVV 44 <br /> ❑ X) Type of r, n or Size of snrae <br /> From To Dia, C-g t>}r F To <br /> fLit in. Wall ft siz <br /> � <br /> (9) WELL SEALI 50 E <br /> Was surface sanitary seal provided? Yes Ek No ❑ ifres.to depth—�, <br /> Were strata scaled against pollution? Yes❑ Na Ek Interval +t. <br /> Method of sc cement Work started-^ I9 CompI 0 <br /> (10) WAFER LEVELS: WELL DRILLER'S STATIME <br /> Depth of first Avatar, if known This well toss t d tu <br /> ander rfs ion a report Is true to the beat of my <br /> Standing level after well cornpleti [; kodtoledge b <br /> xW <br /> (II) WELL TESTS; STG�ED <br /> Was well test made? Yes El Nn <br /> DX If yes, by whom (WeR DrA! ) <br /> Type of test Pump❑ Sailer❑ Air lift E lPanera allInc. <br /> Depth to water at slum of test �h. At end of test k NAN�E <br /> f,E,F�rsl�t,� rr[ � o rtjTy nrfnted) <br /> 0a,01. <br /> after, Lours Water tempera Addres3tcal analysis made? Yes p No{3If yes, by whom? City — Oakdaler Calif� Ztn 93361 <br /> lectr{c In made? Yes ❑ No ❑ If yes,attach copy to this report Llconso No �33114 Date of this report_11 �3 80 <br /> OWR 188(Rav7.76) IF ADDITIONAL.SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUM13ERED FORM <br /> ii <br />