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(5) EQUIPMENT: <br />Rotary Reverse <br />Cable Air ElK <br />Other Bucket 0 <br />(7) CASING INSTALLED <br />Steely:j Plastic 0 C c\:\ <br />ORIGINAL <br />File with DWR <br />Notice of Intent No <br /> <br />STATE OF CALIFORNIA <br />THE RESOURCES AGENCY <br />DEPARTMENT OF WATER RESOURCES <br />WATER WELL DRILLERS REPORT <br /> <br />Do not fill in <br /> <br />No. 22652 <br /> <br /> <br />Lt3 \ • <br />State Well No 4)1.' 1;-):•-"" 76-889W Local Permit No. or Date <br /> <br />Other Well No.."VV/6.41". 7.3 1(.5 <br /> <br />Ae <br />CI <br />(2) LOCATION OF.WELL(Seeingmdiom); <br />County San Joaquin Owner's Vell Number <br />Well address if different from above <br />Township_ T3N Range R6E Section <br />Distance from cities, roads, railroads, fences, etc, Thornton Rd. <br />North of Eight Mile Rd. West side <br />(12) WELL LOG: Total depth_5_15.ft. Depth of completed well 45Q <br />from ft. to ft. Formation (Describe by color, character, size or material) <br />Top soil <br />3.5 Clay <br />5-9 Sand <br />9-34 Clay <br />34-37 lax Sand,. <br />Fine Blue sand <br />From Dia. <br />ft. Etc( > in. <br />0 4 <br />WELL LOCATION SKETCH <br />r <br />Wall <br />s\;\ <br />(6) GRAVE. PACK: \:\/ <br /> <br />r.",4cksqqN si2e,u1,eLso\o <br /> <br />'.'.-LQ:eter of bore <br />corn , \t 450 <br />(8.)';''PERFORAIS 10UVe red <br />Type of pe#tiTrtitm ei..)izeofsere9fNi,„ <br />Fro g To ,./4,> <br />ft. siZEY <br /> <br />150"Z 450' \ I 85c2 <br />( 3) TYPE OF WORK: <br />New Well X Deepening 0 <br />Reconstruction <br />0 <br />Reconditioning <br />Horizontal Well <br />Destruction 0 (Describe <br />destruction materials end <br />procedures in Item <br />Industrial \ <br />Test Well <br />Sti7i'bk <br />MunicipaN. <br />cst <br />Other <br />Glay & shal e <br />165-2010 -Good sand <br />B11(0 cla & shale <br /> <br />200-20, <br /> <br />06-212/ iiue sand <br /> <br />2-223 Be clay <br /> <br />-.22 7 s tre' blu and <br />37.-1f9 spla. y <br />49-57 30,4,,, <br />57-64 <br />4 <br />ofir'" <br />.=69 \ San'. <br />697-1.3 <br />Domestic 2 51-43 <br />hr,,,,,tion/F, Er 33%O.T.-35 <br />(4) PROPOSED RS 230-25,1 Fa ir ,1:1,Ssnd <br />o Blue' clay <br /> 5-390 ine blue sand <br />'T390-4,3, ue c ay' <br /><592.,:460 IFilitlue sand <br />227-2 'sue clay'\A <br />\' 4 3040(:r" Blue sand <br />4 Blue clay <br />/CB 5 <br /> <br />,:kftr415 Blue cla y <br />( 9) WELL SEAL <br />Was surface sanitary seal provided? Yes 0 No 12C If yes, to depth_______ft. <br />Were strata sealed against pollution? Yes ID No 9 Interval It <br />Method of sealine, Work: started 127_Completed_ ___19_ <br />( 10 ) WATER LEVELS: <br />Depth of first water, if known <br />Standing level after well completion <br />Was well test made? Yes 113 No <br />( 11) WELL TESTS: <br />If yes, by whom? P.G.&F.„ <br />Bailer 0 Air lift 0 Pump X <br /> ft. At end of test_____ ft <br />gal/miss after 11 hours Water temperature <br />Chemical analysis made? Yes 0 No 24 It yes, by whom/ <br />—,ctric log made? Yes D No If yes, attach copy to this report <br />WELL DRILLER'S STATEMENT: <br />This well teas drilled under my jurisdiction and this report it true to the best of rny <br />knowledge and belief. <br /> <br />SIGNED <br /> <br />Address <br />NAME Hennings Bros. Drilling 6 0.4 Inc. <br />25 o oFeVi:' Byttaboreration), ( Typed or printed) <br />(Weil Driller) <br />city Modesto Ca if.. zip 95350 <br />License No 2908133 -1. Date of this report 2=21-77 <br />Type of test <br />Depth to water at start of test <br />Discharg3 3 60 <br />_ (80 (R4V. 7-76) IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM 4382G-950 7-76 SOM QUAD 0),T OS.