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i <br /> ORIGINAL STATE OF CALIFORNIA DO not fill in <br /> THE RESOURCES AGENCY {�{ <br /> . . File With E)WR DEPARTME=NT OF WATER RESOURCES No. 0979 <br /> 38 <br /> of Intent No. WATER WELL DRILLERS REPORT <br /> pp State Well No. f i <br /> �., . Permit No. or Date V 1- - 2 Other Well NO.'12ft 24 <br /> �� ©rl � '� <br /> tl � <br /> Address 3!31 �• West Ripon Rd. <br /> � from #t to ft Formation (Describe by color, chaneter, size or mntertal) I <br /> pon>' a - �+ <br /> City 7.ip f : <br /> (2) LOGATTOOF WELL (Seeinstruetions): ` <br /> County J oa Owner's Well Number <br /> rn� i <br /> Well address If different from above G4 36 Sand <br /> Township ItanAe _ ESect[o 36- 40 la L <br /> Distnqce from cities,mads,rallroads,fences,oto Y• corner O 40- d and x'ay e1. <br /> Jack Lone and W. Ripon ;d. $- 5 <br /> man <br /> (3) TYPE OV WORK: ay <br /> New Well N Deepening❑ 1 any Cay � <br /> s ,I Reconstruction p 13tkW a <br /> Reconditioning 0 <br /> i <br /> �r� � tvf�s-J�-'I'jJ�1 Horizontal Well ❑ — <br /> Destruction 0 (Describe — ay <br />' destruction materials Will <br /> procedures In Item - e C <br /> D (4) PROPOSED r <br />€. 1� Domestic i7 — J�ackeu <br />} {�� Irrigation 419+ <br /> Industrial p <br /> 1 t/ T Welt q = Qa <br /> Stec <br /> ( � Muaitip. <br /> WELL LOCATION SKETCH ` Other <br /> n ❑ 1 cover wag install d onLn <br /> (5) EQVIPI%IENTt (6) GRAY 1 ACK: <br /> I4 % altaring or remaying of the <br /> �s 9 B' <br /> Rotary [] Reverse Q ❑ No Size <br /> i <br />'. Cable Air ❑ ter of bore — casing.- <br /> Other <br /> y j <br /> Other �] Bucket [] iso t — <br /> (7) CASING INSTALLEOi (ill ERFORA c <br /> Steel[:k Plastic ❑ it�,e` Type of pe n n or of scree <br /> From To Dia. Gs CLO Fr To ) <br /> ft. Et. , wan ft ft, icy <br /> SIM 0 <11 - <br /> F. f <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yes❑ No IR If yes, to depth— ft. — l <br /> Were strata, seaIed against pollution? Yes❑ No R Interval ft - <br /> Mothad of scaling 1Vmk started. 9 Complot,wl l9 <br /> (10) WATER LEVELS: WELL DRILLEWS STATEMENT: <br /> Depth of first water, If lata Thls well was dr t Hader n, far ellen i t report is true to the best at my ` <br /> Standing level after well completion knowledge aPr&I a <br /> (11) WELL TESTS: SIGNED <br /> Was well test made? Yes d No (a If yes, by whom? #W c 4 <br /> Type of test Pump E) Bailer❑ Air lift❑ NAME Panero We1.1. Vr11 ns1 Inc. ^^ <br /> Deplh to water at start of test ft. At end of trot_ ft ( on rm, x trorparah p) (Type�or pripted) <br /> 3143 e. sone free ttbaCl <br /> arge� _ aI[piin after hours Water'tempem Addres :t <br /> City C1alCcia].e Cali 361. <br /> irtt,analysis'made? Yes 0 No ❑ If yes, by whom? y 1 <br /> 14 <br /> T!'-dectric log made? Yes© No f-1 If yes,attach copy to this report Lieonse No. L ate of this report � <br /> OWR!SB'jRev.417.) :a �Ir ADDITIONAL SPACE; 15 NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br /> �.,+. •i. t, 1. 1 <br /> h <br />