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---SAORMICAU STATE OF CALIFORNIA DO not fill 1H <br /> a- 911 7V THE RESOURCES AGENCY q coq <br /> lOCAa1'N�f@AMll�f DEPARTMENT OF WATER RESOURCES No. 150881 <br /> Notice of Intent No. WATER WELL DRILLERS REPORT state Well No. <br /> Loe:d Permit No. or Date - I;Fi�1�f LtK) Other Well No. <br /> (1) OWNER: Nam stne Toomano (12) WELL LOG: Total drpth �fe Depth of completed well L n _ft. <br /> Address from k. to R Formation (Descrihe by Dolor, character, size or material) <br /> CityFrench C&4, fes k. Zip 95231 0 - P <br /> (2) LOCATION OF WELL (See instmctions): <br /> c lay <br /> Cmunty Son josqu� _Owners Well Number _ 20 Sand <br /> Well ad'dless if dif rrom from above1-166 Fisk IWO 2( - 25 clay <br /> Townshryx8=h.-C=pixng Sectio r <br /> Distance fmm cities,mads, railroads, fences,ete. <br /> - 62 S ' <br /> r3 <br /> (3) TYPE OF WORK: <br /> pit <br /> New Well 6ml Deepening ❑ 125 333 <br /> Revowdruction ❑ - <br /> Reconditioning ❑ - <br /> Horizuntal Well ❑ - <br /> Destruction ❑ (Describe - <br /> 'p(tUoe(,L+-OL yy d sies materials ap$, <br /> -G — - -'t- - x:� procedures in Item - <br /> eL (4) PROPOSED USE: <br /> Domestic <br /> -l' Irrigation ❑ - <br /> �' i Industrial ❑ - <br /> ��� <br /> Test \M1'ell ❑ - <br /> �� Stork (,] - <br /> flunk mat ❑ <br /> WELL LOCATION SKETCH j Other ❑ - <br /> (5) EQUIPMENT: (R)yGRAVEL PACK: - <br /> Rotary1 Reverse ❑ Yes A] No ❑ Siz - <br /> Cable ❑ Air ❑ Diameter of - <br /> (Aber ❑ Bucket J Packed from���_to - <br /> (7) CASING INSTALLED: (8) PERFORATIONS: :ZD - <br /> steel ❑ Pla.6e r Concrete ❑ Type of perforation or sizc of screen <br /> From To Dia. Gage or From To Slot <br /> ft ft. in. I Wall ft. ft. size - <br /> (9) WELL SEAL: <br /> Was starts" sanitary seal provided? Yesremit No ❑ If yes, to depth---5k—ft. <br /> Were strain sealed against pollution? Yes ❑ No ❑ Interval k. - <br /> Method of sea' Work started 19 Complel m <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if known k This well was drilled under m <br /> Standing level after well completion k. p jurisdiction ones this report is twe to the beet of my <br /> kmwkdge ones belie/. ' <br /> (11) WELL TESTS: SIGNED <br /> Was well test made? Yea ❑ No ❑ If yes, by whom? (Well Driller) <br /> Type of test Pump ❑ Haller ❑ Air lift ❑ NAME CalI ' <br /> Depth to water at start of test k. At end of test k rson, rte, or curporahon yped or int <br /> Discharge---gal/ad. after hours Water temperature Address 300 21- Kilroy <br /> Chemical analysis made? Yes ❑ No ❑ If yes, by whom? City Turlock (1 Calif. yip 753811' <br /> Was electric log made? Yes ❑ No ❑ If yes, attach cupy to this report License No. ate of this repo <br /> DWR 188 (REV.7.161 IF ADDITIONAL SPACE 15 NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />