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QUADRUPLICATE 5r,(7EpF_GALIFORNIA )� Do not ll in <br /> Use l r wm 1 with fill II comply THE RESOURCES q ROES AGENCY JAN � �fJ <br /> local requirements DEPARTMENT OF WATER RESOURCES 1979 0. 085336 <br /> Notica of Intent No. WATER WELL DRILLERS ftfQ� UIN 't Is Wen No. <br /> Local Pemdt No. or Date 3 HEq�rH DIN L e2 en Nn. 757 -LYs9 - <br /> (1) OWNER: Na, Al Fonseca (12) WELL LOG: Total depth 208 t. Depthof rompleted well 210e. <br /> Address�y� rpm ay from ft. to ft. Formation (Describe by color, character, size or material) <br /> City ✓�Qn ecag a• Zip 0 - a0 <br /> (2) L CATI N OF W (See instructions):ELL 1� Sand C <br /> t_ <br /> County ZL �oadMle <br /> ia Owoer's Well Number we� #3 10 - 1 Cla said a ren <br /> Well address if different from above Wast 1 -—15 C <br /> Township Range Ser.y`in y� - a <br /> Distance fmm cities, meds, railroads,fences,etc— <br /> tc A i Y ^aye - a &' sa�yy strea s <br /> North of Hest Ri R so IWWW Was - <br /> of Airport Na - ay & sand s ren s <br /> Sand <br /> (3) TYPE OF WORK: Clay <br /> New Wan` Deepening ❑ 406 <br /> Reconstruction ❑ 6 - ue sa e q s ren s <br /> Reconditioning ❑ - 92 <br /> QM <br /> t,LQ sa & shale <br /> Horizontal Well ❑ - I 0j, Blue clay sn strealfs <br /> Destruction ❑ (Describe - 136 \:y an <br /> destruction materiels _ <br /> prnmdures in Item - Clay <br /> (4) PROPOSED — Sand <br /> Domestic 1b2 . - Clay <br /> IrrigationO 1 b : - and <br /> Industrial ❑ 200 22 Blue clay se szre&KB <br /> NZZ\WeB� ❑ 22 %- 23 Sand <br /> Sme 231 13-Lue c ey <br /> WELL LOCATION SKETCH Other L ❑ - a <br /> W(a) EQUIPMENT: (8) GRA PACK: - 4v? Sam & stmle streaks <br /> Rota, ❑ Reverse No S'z � <br /> 2 7-t Clay <br /> Cxhle L] Air ❑ 61 ' <br /> obore 260 Fine sand <br /> Other ❑ Bucket ❑ 2 - NO blue sand clay streaks <br /> (7) CASING INSTALLED (8) PERFORA S: - I <br /> Steel a Plastic ❑ Cr. t Type of pe o or a of scree From T Dia. G r F TO — <br /> ft. f in. Wall f . ft. <br /> 1W 21 -f3LI I - <br /> 150 x2 - <br /> —f <br /> (9) WELL SEAL: — <br /> Was surface sanitary seal provided? Yes (� No ❑ If yes, w depth 12 ft - <br /> Were strata sealed a einst pnnution? Yes ❑ No ❑ Inten al t. - <br /> Method of sea' -oasren elf Work started 19 Completed- 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if kno ft. This weir ums drined under <br /> Standing level after well comuletiov ft. 'ny jurisdiction v9£I this report Is true to the hart of my <br /> krowledge and beliet. <br /> ) <br /> (11) WELL TESTS: SIGNED <br /> Was wen test made? Yes No ❑ If yes, by whom? (Well Driller) r <br /> Type of test Pump Bauer ❑ Air lift Qj. NAME Hennings Bros, Drilling% Coat jneo <br /> Depth to water at start of test ft. At end of tea[ --ft ersnm fjmi, ry, dog) (Typed or printed) <br /> Discharge 28 al/min after boars Water temperature Address 352 Pela Ada le A♦e• <br /> Chemical analysis made? Yes ❑ No J1 If yes, by whom? G;b Modesto l Ca• zip 9 <br /> 5350 <br /> Was electric log made? Yes No Ll <br /> If yes, attach copy to this report License No 291/013 Date of this repo L 12-27-78 <br /> DWR 188 (REV.7-7e1 IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM <br />