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,r� �w 4 <br /> ' rZj���`:Nrf z STATE OF CALIFO NiA DO riot fill in <br /> Zopy THE RESOURCES AGENCY <br /> DEPARTMENT OF WATT~ RESOURCES No. 246363 <br /> N,gice of Intent Nu. __ WATER WELL DRILL RS REPORT <br /> Statr �tie•1] Nu. <br /> G,cal rcmait No. or Date <br /> Other Well Nn. <br /> (1) OWNER-- tint„r__ City of Dodi (12 1 WELL LOG: <br /> ` ` Total depth—it. Depth n{c•n,npleted well ft. <br /> Address— _P•O. .tial, 320 farm i. to ft. F11—I&,-n IDe,c6he harac-ter, size or material) <br /> Cit,. Lodi zip 3y4r1— -- Casing <br /> 10-5 <br /> (2) LOCATION OF WELL (See io5tntctians): B.Lani <br /> 195 Pati <br /> OwTier's Well Number _ � O <br /> Well address if different faro, shfiv 19 <br /> - 215 Standard 1gymered <br /> To-nsLip Range Section_ 21 245 Flu f 1 <br /> Distance front cities, roads, railrnrtds, fences, etc. 2.11 250 Standard louvered <br /> 25 - 275 Flu flo <br /> 27 - 230 . Standard louvered <br /> 23 - 295 Flu flo <br /> (3) TYPE OF WORK. 2a - 305 Standard louvered <br /> New well ❑ Deepening ❑ 30 - 320 Flu flo <br /> Recnnstructinn D 32 335 Standard louvered <br /> Reconditioning ❑ 33 - 350 Flu flo <br /> . Horizontal Well ❑ 350 - 358 Blank. <br /> Destruction ❑ (Describe <br /> destruction materials and <br /> procedures in Sten, 12)' - - <br /> (4) PROPOSED USE: - <br /> i - <br /> Domestic © _ <br /> .. Irrigation - <br /> Industrial ❑ <br /> Test Well C1 _ <br /> Sisxk 0 _ <br /> municipal ❑ - .. <br /> WELL LOCATION SKETCH Other - ❑ ' <br /> i.7,) EQUIPMENT-, (6) GRAVEL PACK: - - - <br /> l4otan- ❑ Revere ❑ Yes ❑ No 0 Size <br /> Cable ❑ Air Q Diwneter of bore - <br /> Other ❑ Bucket ❑ Packed <br /> (7) CASING INSTALLED: (8) PERFORATIONS: - ' <br /> Steel ❑ Plastic 0 Concrete-L] Type of perforation or size r,f screen - 1 <br /> `a = °”" '- i". i <br /> Front ToDia. Gabe or From To Slot - <br /> ft. ft., in. Wall ft. ft. size - � n r� C t�i�5 <br /> f,B�P, <br /> 2011 4 <br /> - !I Vi , L HEALTH <br /> (9) WELL SEAL: - <br />- �'as surface sanitary seal provided? Yes ❑ No 0 If yes, to depth ft. <br /> Were strata sealed against pollution? Yes-0 Nn ❑j Interval - <br /> Method of sealingWnrk ,:a ed�':a !9 Crn,ipieted 19 <br /> (10) WATER LEVELS: NVELT, D1iILLER'S STATEMENT: <br /> Depth of first water, if ,rt' <br /> _ ����=a �„ This u, 11 wasdri[!ed under mU ittrisdiction rend this report is tare to the best_ of my <br /> Standing level after well "mliletinss i fr knoule a and belief. <br /> (I1) WELL TESTS: SIGNED <br /> Was well test made? Yes ❑ No ❑,' if yes, by wham? - -(well Driller) - - <br /> T�pe of test Pump ❑ _ _ !'Bailer ❑ Air L'ft ❑ - T <br /> �;1Ai Arthur & drub W>r11 Drilling Co. <br /> Depth to water at start of test ft. At end of test ft (Penn, firm, or corporation) (Typed or printed) <br /> Discharge gal/njj6 tear = r ou 3 \�rfar irs�eraftve Conejo Addt <br /> 3262 <br /> Chemical ana]ysis made? 'Yes f''I No ]f ves. b% whn� jX City Fr,28i10 CA zip 937 25 <br /> F:: `_,� ,'- ...� _ - 361.319 <br /> 'Xas electric Ing made? 1°es-❑ <br /> No [! If vas, attach co, this report License No. Date of this report <br /> -b\,VR t-&e [REV. 7.70) IF ADDITIONAI, SPACE IS NEEDED, USE NEXT C NSECUTIVEL•.Y NUMBERED FORM - <br />