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ATE <br /> i 1 x- STATE OF CA Li FO NIA Do not fill in <br /> 4y, `- <br /> Y t oscopyTF]E RESOURCES AGENCY <br /> iw DEPARTMENT OF WATE RESOURCES NO. 246362 <br /> x.,tice of Intent N,j WATER WELL DRILLERS REPORTState Well No. <br /> N <br /> I1,ca[Permit No. or Date - <br /> Other Well Nn, <br /> came <br /> (12) WELL LOG: Tr,tal dr,t j 60 —ft. Depth a>F completed well 338 ft. <br /> .-tr3t£rrss `� Enmi ft io ft. Fnnn:ti�,n {Describe by color, character, size or material) <br /> City T ndi7ip95241 6 - r <br /> ill <br /> (2) LOCATION OF WELL (See instruction_c): I - S :Id <br /> C-111ilty Owner's Well \umber 11 18 Clay <br /> Well address if different from above 18 45 Sand <br /> Township Range Sectio 45 - 51. Clay <br /> LDistance from cities, roads, Gulroads, fences,etc.2 mile West of So. Havis 51 — 64 Sand <br /> 300' south of !Lwy 12 West ._64 -- 88 Clap <br /> 88 - 115 and <br /> h <br /> 115 - <br /> 168 Clay <br /> t (3) TYPE OF WORD: 175 Sand <br /> New Well4] Deepening ❑ I8 Clay <br /> 0 19 Sand <br /> Reconditioning ❑ 212 Clay <br /> Horizontal Well ❑ _ z5and <br /> y Destruction C] (Describe — ay <br /> Hwy 12 West deAniction materials and ^e <br /> procedures in Item 12)' — _Z70 a <br /> 3001 (4) PROPOSED USE:' 287- <br /> Domestic Q 995 Sand_ <br /> Irrigation ❑ - / <br /> #I , <br /> fndustrial ❑ <br /> X 3` mile Test Well © 125 _ 129 - Clay <br /> -' <br /> r <br /> L Stock . ❑ 2$ 141 Sand <br /> Municipal 341 - -344 Cla <br /> VVELL LOCZrlox,sKETeft Other ❑ 344 - 352 Sand ; <br /> (5) EQUIPIMENT: (6) GRAVEL-PACK: 352 — 360 Clay <br /> �I <br /> Rotary Q Reverse <br /> [d Yrs.® No ❑ Size—well <br /> Cable ❑ Air ❑ Diameter of bore 3 " <br /> ,1 <br /> Other ❑ Bucket ❑ Packed from 0 tn3�8It. <br /> (7) CASING INSTALLED: (8) PERFORATIONS: <br /> Steel IN Plastic ❑ Concrete ❑ Type of perforation or size of Screen <br /> From To Dia. Gage'or From To Slot - <br /> ft. ft. ' in. `Vail ft. ft. _ <br /> 20,r Sze t' 4. 1 jv: '1 <br /> rl ..Ir <br /> rte. <br /> i <br /> (9) WELL SEAL: _ <br /> Was surface sanitary seal provided? Yes No ❑ , if yes, to depth1301ft. IVV1KOVEN` �I ALEgL'�H <br /> Were strata sealed �against pollution? Yes p Nn E: Into rvnlr sr. _ VI �1 <br /> ?siethnd of sealin Work st ed 1 Completed — 19_ S� <br /> (10) WATER LEVELS: \YELL DRILLER'S STATEMENT: <br /> Depth of first water, if known_ -�! g <br /> This we utas driNed under my jurisdiction and this report is tare to the best of mp"� <br /> Standing ]eve] after well completio �({ knouled a and balfef.� a <br /> (11) WELL TESTS: SaGNED <br /> Wrrs well test made? Yes ❑' No C If yes, by whom?' (Well Driller) <br /> Type of test Pump ❑ Bailer ❑ Air hf: 0 F <br /> NAME <br /> Dearth to water at start of test ft. At end of test ftPe ion, <br /> Discharge 'val/min after hours - Water.,tem Address 252 E Cone o Ave. <br /> - peratuse <br /> Chemical analysis made? Yes p No ❑ If yes; by whom? CityFresno, CA zj,93725 <br /> Was electric )oa made? Yes ❑' No ❑ If yes, attach copy to this report Licrnse •n,361319 nate of this report__7'1—R? <br /> GWR 188 (REV. 7.75) .IF ADDITIONAL SPACE IS NEEDED. USE NEXT C014SECUTIVELY NUMBERED FORM ' <br />