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STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill in <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> 0 WATER WELL DRILLERS REPORT No r3 U .� ,�D <br /> Ice of Intent No state k�ell No <br /> Local Permit No or Date <br /> Other %%elf No <br /> (1) OtiV NER iNamc Jennaro Pro er'-ies (12) WELL LOG Total depth 29 it Completed depth 2_ft <br /> Addre,. j2-U Weigman Road from ft to ft Formation (Describe bN, Lobe character size or material) <br /> C ity Hayward, CA, - ZIP 0 — 6 <br /> (2) LOCATION OF WELL (See instructions) <br /> Counts San JoaC[Ijan Owners Well Number MW—J 6 5 — grained, <br /> Well address IF differ nt from above — anquia-,well -sorted- <br /> Township Range section LV 9 5 11 SILIX CLAY. grAy—hrnwnt <br /> Distance From cities roads, railroads, fences etc <br /> 11 - 12.5 sAND. � ed, <br /> - silt <br /> 1tY, <br /> (3) TYPE OF WORK J sandy <br /> New Well EX Deepening ❑ 14 5- 16 — ed <br /> Reconstruction ❑ <br /> Reconditioning ❑ 16 <br /> Horizontal Well ❑ 11 , CLAY STL;D:; uri -rust <br /> Destruction ❑ (Describe <br /> destruction materials and pro- 1_, ' ; <br /> cedures in Item 12) �. <br /> (4) PROPOSED US \,�= 21 -qANnY T um hrown,i _ <br /> Domestic ! ` �:— ' <br /> Irrigation Q 21 ^ —g ra 71 n ed r <br /> Industrial ,3 * ❑ _ - �" <br /> Test Well �` � ❑ 2. _ 24 <br /> Munici �.r ❑ _ <br /> O4her �' <br /> 24 - 25 L'IrAYr wattled tan rust and chalky <br /> WELL LOCATION SKETCH r r(Bexribe)Mori'1tor,.�,ng — --- f Siihlte. <br /> (53 EntilPk4ENT (6) GRAVEL PACK 25- 26- VERY SILTY CLAY; reddish brown, <br /> Rotary © Reverse ❑ Yes ] No Size^ X26, --27 SAND, multi-11thic c a - ed, <br /> Cable ❑ Aar ❑ F met of bore - angular. <br /> Other ® Sucket--.Q Pacl�ed from�.�____to �A €t — 28 CLA�r i tan brown 51Zt <br /> r 1-1 V �, ` -1 s - 29 SAND multi lithic <br /> (7) CASING INSTALLED (8) PE TI — razned angular, well— <br /> Steel ❑ Plastic f a Ty of o on or size of Q — <br /> From D Gage or t — <br /> ft f Wa11 t size IT - <br /> v - <br /> (9) WELL SEAL <br /> Was surface sanitary seal provided? Yes fI( No ❑ If yes,to depth _ 7 it Were strata sealed against pollution? Yes ❑ No ❑ Interval it — <br /> Methodofsealing cem nt bent niLte grout Work started_ JulV 22- ___19-8$ CompletedJu1Y22 <br /> (10) WATER LEVELS WELL DRILLERS STITENIENT <br /> Depth of first water if known _ - ft <br /> This well was rin!!t d ru:dc r my Irera[l#cfirrrt and this repvrt rs trot: to the <br /> Standinglevel after well completion It lest of my knowledge and br lu J D I <br /> (11) WELL TESTS Signed 555���.����1 '�„/ <br /> ell test made? Yes C1No 1R If yes by whom? (We Driller <br /> if test Pump ❑ Fmiler © Airlift ❑ NAME <br /> kh to water at start of test ft At end of test It (Per-Ain firm or co iration)1Typr d or printed) <br /> Discharge gal/min after hours Wattr temtu rature Aild[ess G— <br /> C hi.mlcal anAysis made? Yes QC No [� If yvs by whom t ity ` 711'TY �w 7 <br /> Was claatrtC big made Yes El No If yes attach ropy to this report Licr.nse No 7 !; Date of this rt port <br /> DWR 108 (REV 12-96) IF ADDITIONAL SPACE IS NEECED USE NEXT CONSECUTIVELY NUMBERED FORM 86 96355 <br />