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'ORIGINAL STATE OF CALIFORNIA Do not fill In <br /> THE RESOURCES AGENCY No. 40479 <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> \nt�ce of Intent ,vn �J QQ WATER WELL DRILLERS REPORT State Well 1u <br /> it Perintt NO or Dite + _/1 � Other Well ho � `' <br /> OWNER ivy��1e Andrews Rossi (J2) WELL LOG Total depth 175 It Depth of completed weldZ-ft <br /> Address x-7659 S. Airport Way from ft to ft FnrmItlOn (Descnbe by color charncter size nr miterlil) <br /> City Manteca C lif. -zip 0-1Sand <br /> (2) LOCATION OF WELL (See instmetsons) 15-20) Blue clay <br />'County oa Uiri Owners Nkell \umber 20-27` and <br /> NVell address if different from tbove ��LL 27-29—2 <br /> TosvnshipTls Range R&F, _.Sectio — <br /> 46 <br /> Li. <br /> ince fmm cities roads rntlrOids, fences etc �,.`` Cla shale <br /> Nor -h-. of Hwy 120, s s d 75-83 \ and gravel <br /> ay <br /> ' <br /> 94-11b Shale clay <br /> (3) TYPE OF WORK Il band <br /> Nest' VI els_V Deepening ❑ l <br /> Reconstrucnnn ❑ — an gravel <br /> Recu nditmmnj, ❑ <br /> Horizontal Well ❑ \ti`s - �� <br /> Destruction ❑ (Descnbedestr <br /> ' <br /> procedurestjt;u <br /> n Item <br /> an <br /> pr<xedures m Ttem I2) <br /> (4) PROPOSED >ET - ^ <br /> Dnme%tIL <br /> Jrngition �*s - \ <br /> ' Industr,-il �X, ti ❑ 7- - <br /> 'Kest �%ell / ❑ <br /> Stock <br /> s Municipal <br /> WELL LOCATION SKETCH ��d Other 1\ ❑ -�:\ "A <br /> 11,31 EQUIPMENT (6) GRAY X,PACK � <br /> r <br /> Rutiry X] Reverse El No ❑ Size c�a < <br /> C sble ❑ Air ❑ t`e�er nF bore <br /> 12 <br /> Othcr ❑ Bucket ❑ ����ced from 13 to+ - <br /> ,(7) CASIhC ]INSTALLED.4r (S) PERFORATIO\5 and cut"� _ <br /> Steel F1 Plnstic Conc7 t Type of pe ia�ion or size of screen IN <br /> Frons To Dia G g 14 Fr \u Io ? <br /> ft ft!T >to Wall f ft sizes4 = <br /> 1 160W \' 17 ri.,' <br /> '(9) WELL SEAL J� 50 - <br /> assurf ice sanitary sell provided' Yes 1X No ❑ if yes to depth 50 <br /> X�ere stilt, sealed againstpnllu ionJ Yes F] No Ellntery it ft - <br /> hfethod of seahn Bentonite Work starte3 g__yLoCompleted- <br /> (10) <br /> omplete(1D) WATER LEVELS WELL DRILLERS STATEMENT <br /> Depth of first water if knoyy ft 7hrs tcefl tLas drilled under my jurisdiction and this report n true to the best of my <br /> flandmg ]eycl after well complettun <br /> 1 ft knowledge and belief <br /> I0 WELL TESTS SIG\EDas well test `nide? Yes ❑ to CK If res bs whom, (Well Driller <br /> Type of test Pump ❑ Bailer 0 Air lift ❑ NMNIE Hermin S Bros Drilling CO Inc.- <br /> Depth to utter at start of test ft At end of test ft isona or co ration (Typed or printed) <br /> Address 2 5` U99 e h• <br /> Discharge gaI/rxsin after hours ��atea temperature City eStO� a1if. Zip 0 <br /> 1-1- analysis niade- Yes ❑ No MUIf yes by yyhom —� -77 <br /> ^iectnc log made) Yes ❑ No If yes, attach copy to this report License No Date of this report ! ! <br /> 1 .fi 188 (REV 7 7e, IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM +98:a 950 7 za soM QUADij>r OSP <br />