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ISTATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill ITL <br /> File With SWR DEPARTMENT OF WATER RESOURCES <br /> IWATER WELL DRILLERS REPORT No. 375521 <br /> 00tice of Intent No, State Well No _ <br /> Local Permit No or Date 90-3229 ooi _ 4D -06 i Other Well No, a4N0.3E04t <br /> I (1) OWNER Name Phoong Venh SU (12) WELL LOG Total depth 250 ft Completed depth 215 ft <br /> Address 6250 Lemon Hill #61 from It to ft. Formation(Describe by color character size or material) <br /> city Sacramento, CA ZIP 95824 0 - 13 Clay <br /> I (2) LOCATION <br /> ON OF WELL (See instructions) 13 _ 23 Blue c1a <br /> County Joaquin Owner s Well Number 23 30 Blue sand <br /> I Well address if different from above 30 - 126 Blue 1 <br /> Township o4lJ Range OSE Section 126 133 Blue sand <br /> Distance from titres, roads,railroads,fences,etc Wa 1 nut Grove Rd.- 133 - 180 B l u c l a <br /> '1=mile west of HKY 5 north side Lodi 180 - 182 Fine s nd <br /> I 182 - 195 I u e c <br /> 195 - 209 sand <br /> (3) TYPE OF WORK 209 — 250 c 1 a <br /> New Well M Deepening ❑ — <br /> Reconstruction ❑ <br /> Reconditioning ❑ <br /> Honzontal Well ❑ — r <br /> I Destruction ❑ (Describe <br /> destruction materials and pro- <br /> N <br /> eedures in Item 12) <br /> (4) PROPOSED US <br /> Domestic <br /> Irrigation �� \ <br /> �11<� V <br /> Industrial ❑ <br />' Test Well ❑ �� <br /> O er <br /> WELL LOCATION SKETCH tbe) <br /> (5) EQUIPMENT GRAV CK S a f CJ NJ <br /> Rotary Reverse <br /> Rota ❑ No Si <br /> I Cable — <br /> ❑ Air Q W-Ld <br /> of bore � <br /> Other ❑ Ruck .,r50 XXX_ ` <br /> (7) CASING INSTALLED- (8) PER ATION <br /> Steel ❑ Plastic 1 n Ty of an ar size of O = <br /> From TGage or t <br /> Et E i Wall Wt size _ <br /> 0 2 160 115 ZI screen <br />' (9) WELL SEAL = <br /> Was surface sanitary seal provided? Yes [R No ❑ II yes to depth_. X XXL-ft <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval fL — <br /> Method ofsealing Bentonite Work started 19 Completed 19 <br /> (10) WATER LEVELS WELL DRILLER'S STATEMENT <br /> Depth of first water If known ft <br /> completion 18 ft. This well was dnlled under m lurrsdictton a d this report is true to the <br /> Standing level after well tom <br /> P best of my knots d e behej <br /> (11) WELL TESTS ? <br /> Was well test made? D Signed <br /> Yes ❑ No �] If yes,by whom ( II Dr 1 r <br /> o(teat Pump ❑ Bader ❑ Airlift ❑ NAME Hennin Bros. `Uri i��n o. , Inc. <br /> b to water at start of test ft At end of test ft. (P n,firror coTye- <br /> Chemical <br /> ration)(Typed r Tinted) <br /> rg gal/min after hours Water temperature 3'5325 Pee and n a Ty P <br /> Ifa a Address, sr <br /> Chemical analysis made? Yes ❑ No Iq� if yes,by whom? City Modesto, -CR- ZIP 356 <br /> Was electric log made Yes ❑ No I�Ad�I, If yes,attach copy to this report License Na 290213 Date of this report <br /> owR I08 iREV 12-8" IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM 9a5$ <br /> I <br />