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STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill to <br /> File with DWR DEPARTMENT OF WATER RESOURCESr. , . 'r <br /> WATER WELL DRILLERS REPORT N0. 2 G ` z L <br /> eta of Intent No %tate Wt II No <br /> .,ocal Permit No or Date�� 3 Other Nit ell No io - <br /> (1) OWNER Name (12) WELL LOG To(aI dep(hA•9' ft completed depth A --- ft <br /> Addres% Mi w from ft to ft Formation(Desenbt bN color character size or material) <br /> Cit, rne)J _ ZIP _ <br /> (2) LOCATION OF WELL (See Instructions) — <br /> County S215 ii liil/l Owners Well Number <br /> V1 ell address if different from alxlve <br /> Township 2S- Range 5tE Section w <br /> Distance from cities roads railroads, fences etc <br /> (3) TYPE OF WORK — N <br /> �'p"7��"*vim+ +► New Well jo Deepening ❑ <br /> Reconstruction ❑ <br /> Reconditioning ❑ r <br /> KW-Z Horizontal Well ❑ � <br /> ® Destruction ❑ (Describe <br /> destruction materials and pro <br /> cedures in Item 12) _ <br /> W►1��n (4) PROPOSED USE <br /> E <br /> Domestic ❑ — _ <br /> Irrigation ❑ — <br /> Industrial ❑ _ _ <br /> Test Well L,] _ - <br /> �,. Municipal ❑ _ <br /> Other R <br /> WELL LOCATION SKETCH (Describe) ] <br /> (5) EQUIPMENT (6)I PACK ^r <br /> Rotary ❑ Reverse ❑ .� Yes'1'!� No 0Siz <br /> Cable ❑ Air ❑ `Dta — .v <br /> a�ejoF bare <br /> Other J4 Bucket--Cl Packed from a+ <br /> (7) CAS NG INSTALLED (8) PERFORATIONS <br /> Steel ❑ Plastic in n e Type of porforaLon or size of screen — <br /> From To, DW Gage or -From Tv 'Slot — <br /> ft ft,\ ` 'p , Wall ft., ft size — <br /> 0 44 Z- 0 - <br /> (9) WELL SEAL <br /> Was surface sanitary seal pro%Idled? les)l No ❑ If ves to dt pih 3;5r ft — <br /> Werestratasealedagainstptdlutiou? Yes K No ❑ Inttrval-_'�er— 0 It — <br /> Method of sealing Work started 19 f ompiett d 19 <br /> (10) WATER LEVELS WELL DRILLERS STATEMENT <br /> Depth of first miler 1f known _It <br /> 7lns we l! � Iled undtr my 1urrsdiciinn d ty report as fent to liteStandinglevLlaflt,rxellcomplttimr It Iv"t <br /> of r7 nu t t and I""I"f <br /> (11) WELL TESTS %Ignt d <br /> Was well test madeO lis ❑ No X If Y4 hs ahtom� Il IJrolhr) <br /> tet Pump ❑ Rader © Air liftElNAMEcuPECTRUM EXP TIp T04.watt r at start of first It At(nd of It%1 I1 (Poison firm or rorporatuin)(Typed or printed) <br /> Discharge ` gal/nun afltr hours W tit r It mperaturt Addr(ss 2R25 F., M V T.R STRERT <br /> Chemical aria lysis niidt� le% ❑ No [D If It% hyHhoui� (its STOrKTON-, CA 71P_ 95205 <br /> Was tit ctritlogmadt les ❑ No ❑ Ifyts attach copy to this report 1_ictnu No Dat( oft his rtport <br /> 4WR 11218(REV 12-88) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM 86 96355 <br />