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STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill ;n <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> IWATER WELL DRILLERS REPORT No. 361948 <br /> Wice of Intent No State Well No <br /> I Local Permit No or Date��2 6 �'iJ F ;/ Other Well No <br /> (1) OWNER Name KQng Lpe (12) WELL LOC Total depth 2-10_ ft Completed depth 1411 ft <br /> Address from ft to ft Formation (Describe b% color character size or material) <br /> I City ZIP = <br /> (2) LOCATION OF WELL (See instructions) <br /> County Owner s Well Number 7 — <br /> Well address If 4iffcrent from above inior = <br /> Township / Range Section 16 <br /> Distance from cite t 2 1 - 24 Blue G o a e Sand <br /> Hwy 5 es,roads, railroads, fences,etc <br /> 24 - 41 Blue Cla <br /> north side 41 - 42 Blue and <br /> 42 - 64 Blue <br /> (8) TYPE OF WORK 6A - 66 1 u e VW Sand <br /> I New Well M Deepening ❑ 66 _ 93 e a <br /> Reconstruction 139 B NN Go o d Sand <br /> Reconditioning ❑ 1 U 6 2,8 Bl u S ha,l e & Clay <br /> I Horizontal Well ❑ 128 --1 3Blue _Fa „San d <br /> Destruction ❑ (Describe 1 -" �B u e, a, /& S h a l e <br /> destruction materials and pro- 173 Me e S-9' d <br /> cedures in Item 12) <br /> 17 b B I u,e--., <br /> (4) PROPOSED USF 1 — 1-8 Blue F 1 Q-e S:aW <br /> Domestic18 0 - 1,99 Blue CJ$ rJ <br /> Irrigation �t"X 199— 2G2 -B 1 u e. S' d, <br /> Industrial ❑I \ Q Blue- <br /> Test Well ❑ } 205 .Blue Fine Sand <br /> Municipal ❑ 2 U b 2172Blue C a <br /> O er . ❑ , , - ,Bxue Fine Sand <br /> WELL LOCATION SKETCH ribe) r — ,Blue C a & Shale <br /> (5) EQUIPMENT GRA V)EL 6ACK S and", — — <br /> Rotary 91 Reverse ❑ Yrs\r( No,6 „size �~ ~ <br /> Cable ❑ Air ❑ Dia_ et of bore r1- �� �� ♦ — <br /> Other <br /> El Buck Eac`�ed rom to 140 <br /> (7) CASING INSTALLED,r,, (8) PER ATIgNS 4 <br /> Steel ❑ Plastic �q, Ty of on or sao of <br /> Fromt Gage or t <br /> ft f Wall t size _ <br /> 1 _ <br /> I (9) WELL SEAL = <br /> Was surface sanitary sea]provided? Yes X No ❑ IF yes to depth. 70 ft. <br /> were strata sealed against pollution? Yes ❑ No ❑ Interval ft — <br /> Method of sealing BENT 0 N I T B Work started 19�Completed 19 <br /> I (10) WATER LEVELS WELL DRILLER'S STATEMENT <br /> Depth of first water if known Ft <br /> Standing leve!after wellowcompletion This well was drilled under m llrrtsdtction and this report is true to the <br /> 1 4 ft best of m knowle a and behef <br /> I (11) WELL TESTS Signed i <br /> 'was well test made? Yes ° No ff If yes,by whom? (well riller) <br /> of test Pump ❑ Bailer ElAir lift ❑ NAME H E N N I N G S B R 0 S . DRILLING CO. <br /> �th to water at start of test ft At end of test ft.El5 2 P grson�fiyn or enrporatlon (Typed or printed) <br /> I Discharge gal/min after ��yyhours Water temperature Address 3 L�A <br /> LE V <br /> Chemical analysis made? Yes No)d 0 D E S T Q If yes,by whom? City a CA -zip <br /> Was electric log made Yes ❑ NoU If yes,attach ropy to this report License No --2-q Q A 1--1 Date of this report 0 <br /> DwR ISa (REV 12-9k" IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM 116 q355 <br />