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0 <br /> IWATIF OF CALllopmA <br /> Vwne�i <br /> IPUATE TKE RESOURCES AGENCY 3 Copy DEPARTMENT OF WATER RESOURCES Don -t,i <br /> WATER WELL DRILLERS REPORT No. 361945 <br /> ' Noticeof Intent No. Slate Well No <br /> Local Permit No. or Date 90-310 4 <br /> Other vti elt No <br />' (1) OWNER Name (12) WELL LOG Total depth 14R fi Completed depth 14.9 ft <br /> Addrea AN from ft. to ft. Formation;Describe b% colnr character size or materlal) <br /> City zip 95201 0 - 5 Sand <br />' (2) LOCATION OF WELL (See instructions) 5 - 25 Clay <br /> County Owners Well Number 25 — 35 Blue Clay <br /> Well address if different from above 35 — 39 Blue Sand <br /> Township Range Section 39 — 61 $ ue Clay <br />' Distance from cities roads railroads,fences etc 61 — 67 B ue 5and <br /> 67 - 108 Blue C I 8 <br /> 108 - 114 Fina Slue' and <br /> 114 - 119 Coat .Blue Sand <br /> (1) T]PE OF WORK 119 - 125 81 ue <br /> New Well&( Deepening ❑ 125 — 1 0 ue and <br />' Reconstruction ❑ 140 - 5 Nv e C I a <br /> Reconditioning ❑ <br /> Horizontal Well ❑ <br />' Destruction ❑ (Describe — �1 <br /> destruction materials and pro- <br /> cedure s to Item 12) <br /> (4) PROPOSED US <br /> Domestic <br /> Irrigation C� <br /> Industrial Q ❑ �v � v <br /> Test Well Munici <br /> E, cr <br /> WELL LOCATION SKETCH ibe) _'� <br /> R id <br />'(5) EQUIPMENT GRAY CA 5 — !+. <br /> Rotary Reverx ❑ Na i �AFmss'+ <br /> table {] Air El et of bore u <br />' Other ❑ Bueke mm = <br /> (7) CASING IN <br /> $f) (8) PER Tt _ <br /> Steel ❑ Plastic Tr erf 4°ri or ria <br />' From T l Gage or t - <br /> ft f t Wall t size _ <br /> reer <br /> (9) WELL SEAL - <br />'W03Surfae:esanit2rysealprovtded;1 Yes,0 No ❑ If)mtodepth It <br /> Were#rata seated against pollution�p Yes ❑ No ❑ Interval fl. — <br /> Met had of'ling Work st irted net"- 19_qZ_ Completed 19 <br /> (10) WATER LEVELS WELL DRILLERS STATEMENT <br /> Depth of first water if known ft <br /> p Thss ui.11 upas drilled undZ m jurisdiction and this repore is true to the <br /> o ring level after well completion .1$—_ft hest of my knouledgeo end bel-I <br /> WELL TESTS <br /> Was cell test rnade� � Signed ` •E L l \.t1����_\]� -.c i <br /> Yes ❑ '�'o (� If vis,by whom [Welt l)niler} <br /> ytxdt� Pump ❑ R.itler ❑ Air left ❑ NAMF <br /> J]iept}i to sealer at start of test ft At end of test ft ;Pei in.firm or mrpnratwn tTyped of pneeteed) <br /> DMh2Z&e ga]/mmaftt,r haerrs Waterteruperat ure Addre+s <br /> rade? Yes ❑ No IM If M by whom? Cr l ti . 0DES10y CA ZIP 9535'; <br /> �* Yea © No If yesatta.h ytothrsreptxl LicerrseNn Date oflhtsreport 90 <br /> i7Wlt fltt0 it3ltV s2.8Qr iF ADDtTtONAL SPACE IS NEEDED USE NEXT CONSECIITSVELY NUMBERED FOFttiit � x,� <br />