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I Il <br /> STATE OF CALIFORNFA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill :n <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT NO. 371925 <br /> •til.tice of Intent No _ State Well No <br /> Local Permit No or Date y /'� f Other Well Na <br /> (1) OWNER Name Ed Vincent (12) WELL LOG Total depth —ft Completed depth G ft <br /> Address 2181 Dunn Road from ft to ft. Formation (Describe by color character size or material) <br /> City Hayward , CA ZIP 95454 <br /> (2) LOCATION OF WELL (See instructions) - <br /> County San Joaquin _ Owners Well Number - <br /> Well address if differe f m above - <br /> Township Range Section - <br /> Distance from cities, roads, railroads, fences, eta <br /> 15752 MCKinley Avenue - <br /> Lathrop, California 95330 <br /> (3) TYPE OF WORK Abando well acC g RuleS and Rerulat <br /> New Well ❑ Deepening ❑ of San Joa4iAn CWjnty. <br /> Reconstruction ❑ Pour cepignt o u t :Rxxx from bottom to <br /> Reconditioning p top t g h t emm pipe . <br /> Horizontal Well ❑ S a n Z t a1 o n S i t <br /> Destruction (Describe - <br /> destruction rhaterials and pro- <br /> cedures in Item 7 2) �� V <br /> 1 <br /> (4) PROPOSED US <br /> Domestic <br /> Irrigation -,- \\ ^ '-\ v <br /> Industrial ❑ r� �ti �� N 1 <br /> Test Well ❑ C <br /> Munici E] <br /> WELL LOCATION SKETCH ibe) <br /> (5) EQUIPMENT <br /> GRAVISL CK <br /> Rotary Reverse ❑ N\.4 Size <br /> Cable CJ Air © et of bore f �I rr\` I <br /> Other - <br /> © Bucket ed rom <br /> (7) CASING INSTALLED• (8) PER ATI - <br /> steel ❑ Plastic ❑ Ty of on or size of Q From Tr Gage or t <br /> £t f t Wall t size J <br /> (9) WELL SEAL <br /> Was surface sanitary seal provided? Yes ❑ No IN If yes,to depth ft <br /> Were strata sealed against pollution? Yes ❑ No 6 Interval ft <br /> Method of sealing Work started Completed 9 <br /> (10) WATER LEVELS WELL D l ER S ST T T <br /> Depth of first water if known Et <br /> Standing five)after well completion ft This well m 11 under m 1 W fon&atreport r t e to the <br /> best of my no a be of <br /> (11) WELL TESTS <br /> Signed <br /> ell test made? Yes El No ® If yes,by whom? (Well Driller) <br /> ftest Pump ❑ Bader ElAir lift C1NAMEQw <br /> to water at start of lest ft At end of test ft ei ( a ?Gan)(Typed or printed) <br /> Disclurge get/min after hours Water temperature Address aSt Charter Way <br /> Chemtcal analysis made? Yes ❑ No 09 If yes by whom? I City- S t o C 1C t o n�_ California zl p 9 5 2 0 5 <br /> Was electric log made Yes ❑ No jr If yes,attach copy to this report License No 371560 Date of this report 2 6 O C t 9 2 <br /> OWR tag tREV 12-88) IF ADDITIONAL SPACE IS !NE=EDED USE NEXT CONSECUTIVELY NUMBERED FORM 66 96355 <br />