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a <br /> a <br /> a STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY DO not ftll to <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT N0. 2 91 Q 0, 1 E <br /> ocl of Intent No 51 1( Wr ll No <br /> oval Permit No or Date 64 —Y 0111(r NN ell No <br /> (1) OWNER ?Same CIC- (12) WELL LOG Total depth ft (ompletcd depth Ft <br /> Address from ft to ft Formation (D(scnbe bs color character size or material) <br /> C th ZIP 'j <br /> (2) LOCATION OF WELL (See instructions) — <br /> (ounts ,S ��t?Vii.?_t,l!► OW ner c Wel; Number <br /> Well address if different from above <br /> Township --Z S Range Section I — <br /> Distance from cities roads railroads, Fences etc `- <br /> f <br /> (3) Tl PE OF WORK — �v <br /> t New Well i?"Deepemng ❑ — V <br /> Reconstruction ❑ <br /> t Reconditioning ❑ <br /> 1 Horizontal Well ❑ `` <br /> aDestruction ❑ (Describe <br /> destruction materials and pro- — — <br /> eedures in Item 12) — <br /> K (4) PROPOSED USE _ <br /> Domestic ❑ , _ <br /> +JfllW Z Irrigation ❑ — <br /> Industrial ❑ <br /> Test Well ❑ _ r <br /> Nlunicipel ❑ _ <br /> Other _ <br /> WELL IOCATION SAETCH (Desertbe) rr _ <br /> (5) EQUIPMENT (6) GRASPACK - <br /> Rotary [(� Reverse ❑ Yes f No ❑ _Stu- <br /> Cable ❑ Air <br /> El 0--,ter <br /> of bore <br /> Other ❑ Bucket ❑ Pat from <br /> (7) CASING INSTALLED �u L (8% PERFORATIONS _ — <br /> Steel ❑ Plastic nZrete Types of pertorutlon or size of se pe _ <br /> l <br /> From To l 'Dia Gage or '-'From To Slot — <br /> ft ftp ` itt , % all ft it size — <br /> r-b 0 --2,-- <br /> (9) <br /> 2.'-(9) WELL SEAL, <br /> Wass(irfacv santlar)sealpnnideKl� le+ 0-l"No ❑ If Nes lodildh fl <br /> Were strata staW agmri,t txdlutton9 its (�� N, Int(rv,il 31(f,,';i Z_ fl — <br /> Method of sealing Worl,started I()� (ontpleted 19 <br /> (lO) "ATER LEVELS J / WELL DRILLER S STATEMENT <br /> Depth of first watt if f.uov,it i It <br /> Van aril tins r dl(d urad(r nay jurndiction anti this rtport tc true to M4 <br /> Standing Ir vd of It[writ(vtntpl[[uiu ft jx s1 uj ru tr t ed�c a Ad lK 1 i(j � <br /> (11) WELL IESrS Was wt]l u s1 inadt,' l t% ❑ No ❑ l l y t N hs wborn o I I Uril tr <br /> or test Purnp ❑ RA11tr ❑ Airlift D NANII- SPECTRUM E 0�2AT 8N, INC. <br /> fth to water at start of tasl ft AI i rid of It tS ft (P(rsrm firm or tY> rat on)(T (1 nr preMrttl <br /> 2825 E MYRTL STREP <br /> DischarF( gal;nunalit r hour. Wat(rl(nitxtalur( Addretit 95205 <br /> Chtinii iIanalysis niadc� Ivs El No El If yis lit"liornO (0\ STOCKTON, CA ZIP <br /> Was eleetnclog made les ❑ No ❑ If yts Ata,lrcopy tot[its refxsrl I i((nsc No 512268 Dal( of thtsr(I)(irt <br /> DWR 188 tREV 12-66) JF AL)DITIONAL SPACE IS NEEDtAD USE NEXT CONSECUTIVELY NUMBERED FORM 66 96353 <br />