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s <br /> \ STATE OF CALIFORNIA <br /> t ORIGINAL THE RESOURCES AGENCY Do not fall in <br /> File with ®WR DEPARTMENT OF WAT1rR RESOURCES <br /> WATER WELL DRILLERS REPORT No. 345816 <br /> 4kotice of Intent No. state Well No,— <br /> Local Permit No.or Date 91-09 78 Other Well Na <br /> (1) OWNER: Name APPIAN ENGINEERING, INC. (12) WELL LOG: Total depot ft.Completed depth ft. <br /> Address 760 .EAST CAPITOL AVE. from ft. to ft. Formation(Describe by color,character,size or material) <br /> City_MILPITAS CA _ _ _ — _ ZIP 95035 DEPTH 120 AI T 8" STEEL <br /> (2) LOCATION OF WELL (See instructions): — WATER LEVEL ' <br /> County SAN JOAQUIN Owner's Well Number <br /> Well address if different from above TRACY BLVD./CLOVER — <br /> Township TRACY Range Section CLEANED WELL TO ORIGINAL <br /> Distance from cities,roads,railroads,fences,etc. — PERF ' <br /> FILLED WITH IR19E <br /> FROM BO 'FO <br /> REMOV ' H <br /> (3) TYPE OF WORK: ma&E 50 E <br /> New Well ❑ Deepening <br /> Reconstruction ❑ — <br /> Reconditioning ❑ <br /> Horizontal Well ❑ <br /> Destruction & (Describe <br /> SEE ATTACHED MAP destruction materials and pro- <br /> cedures in Item 12) <br /> (4) PROPOSED US fVP <br /> Domestic <br /> Irrigation <br /> Industrial <br /> Test Well <br /> Munici Q <br /> WELL LOCATION SKETCH < f <br /> (\CabED] <br /> -. G <br /> Reverse ❑ No i <br /> Air ❑ ete of bore <br /> It ke ❑ om t t. <br /> (7) CASING INS LED: (S) PER T <br /> Steel © Plastl ❑ neete Ty of ar size oF r <br /> From 1 Gage or t <br /> Et. ft. ii. Wall t. size Y <br /> (9) WELL SEAL: — <br /> Was surface sanitary seal provided? Yes ❑ o ❑ If yes,to depth ft. <br /> Were strata sealed against pollution? Yes ❑ ❑ Interval ft. <br /> Method of sealing Work started 19 Completed 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water,if known ft. <br /> Standen level after ft. This well was Tilled under my 'urisdiction and this a ort is true to the <br /> >a best of my kno ler e.and belief. <br /> (11) WELL TESTS: Si Signed <br /> C� <br /> 4*'y-P':-Vf <br /> 11 test made? Yes ❑ No ❑ If yes,by whom? g (Well Driller) <br /> test Pump ❑ Bader ❑ Ai ift Cl NAME CLENN MARTELL & SON, INC. <br /> epth to water at start of test—ft At end of test #t. 1818 LOV 'D fOi �tporntian)(Typed or printed) <br /> Discharge, gal/min after hours Water temperature Address <br /> Cbemical analysis made? Yes ❑ No ❑ If yes,by whom? City TTrTSEM GA ZIP <br /> Was electric log made Yes ❑ No ❑ If yest attach copy to this report License No., 510952 Date of this report 5I3I91 <br /> DWR 1at3 IREV. 12-136) IF ADDITIONAL SPACE 1S NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM 86 9M5 <br />