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Al.16 r+,c Vr Vr�LIF Vr`Tl1A <br /> THE RESOURCES AGENCY Do not fist <br /> File with DWR DEPARTMENT OF WATER RESOURCES No. 36138 <br /> \06(r,j Intent \o WATER WELL DRILLERS REPORT <br /> State Well Vu <br /> Lnc11 Permit \o or I)ue_ <br /> _ Other Well \u <br /> OWNER \,nre_I�ee__Mc—Danny (12) WELL LOG <br /> F-ullPmo Tut�l deptlL ft Depth of completed <br /> kdtlrc+y,�____-2�L1���, �..__ _ - from ft to ft F'orntlhnn (1]es�nllc hti color char <br /> tt•---_- tkn a� Ca _ _ '-- tier Size or mttet1111 <br /> (2) LOC 1TION OF WELL - <br /> Sari JOLIlri (Sic tnti(tltcteonti) 32 <br /> a -� <br /> Ceirgtt,_____ ,�� Quncrs \Lill \umber _ _ - <br /> �1r1] iJdre++ tf diBcrent faun thuac, <br /> £tunshiP��___ lSvn�c <br /> Section_�_�� ( - <br /> I)t+ttnc, troll odes roads nilrn uls Icncrr45 <br /> 50 54 clay — <br /> 54 - 62- sand — <br /> 62 - 90 clay_ <br /> (a) 11PE OF WORSE 90 - 98 sandgtavel - <br /> l)ccpening ❑ 98 -105 clay <br /> Reconstroctntea ❑ 105 1-10 Cly , sand <br /> 1lccrrnJrtromn� ❑ _1 81 clay <br /> Itetn�nnt7t Il ❑ 1 ` -12 6 <br /> 26 Sand �. <br /> 1)"tntclunl J (Descrlhc 3 + clay <br /> destnictlnn ni lten'is lid - <br /> pr,Kedures in Ill 12) - sal , gY'ayC <br /> (4) PROPOSED USE s an �r C air <br /> Vonleutc >CX <br /> Irl itivn ❑ w <br /> Industria] ❑ <br /> Test %%ell ❑ _ <br /> Stock ❑ - <br /> Municipal [] y <br /> SHELL LOCATION SKETCH I Other ❑ <br /> (5) LQUIPMENT (G) GRAVEL PACK _ <br /> Rotary Reverse ❑ Yes ❑ No ❑ Size �_r <br /> Cible [] Air ❑ Diameter of bore_ __ \ ✓ <br /> Other ❑ Bucket Ej Packed fmm <br /> (7) CASING INSTALLED (8) PERFpRATIDhS ��\✓ _ <br /> Steel ❑ Plastic ❑ Concrete (] Ty pe of perforation or size of screen <br /> From To Dia Gage or Prom To Slot - <br /> ft ft in Wall ft. fL size _ <br /> u _ <br /> (9) WELL SEAL _ <br /> Was surface sanitary seal pro%ided? Yes ❑ No ❑ If yes, to depth ,—ft _Were strata sealed against poputrona Yes ❑ No <br /> © lnten.al rt _ <br /> Method of sealing Work started Complet <br /> (10) WATER LEVELS WELL DRILLEIt'S STATEMENT <br /> 19 <br /> Depth of first water if knourr ft <br /> Standing level after cell completion k know�e'ddbelled ander trey ptr7sdfcteon and this iefreport is true to the beat it my <br /> (11) WELL TESTS <br /> srC\FID <br /> 'i'll adf test made les ❑ No ❑ If yes b% uhnialP (1Vell DnEler) <br /> Type of test Pump ❑ Bailer ❑ Air lift ❑ NAME <br /> Depth to water at start of test h At end of test,.._ ft erson, em,or corporateon (IS <br /> y of rm ) <br /> Dischar¢eT�_ryal�min after hours Water temperature Address P.0, bOX 918 <br /> Chemical ar lvsrs madea Yes ❑ No ❑ If ves by whorl City 'S tkn' Z,p 95201 <br /> t' ctnc log made les ❑ \a ❑ If +es attach copy to thas report Lrcerue No W07q4 Date of this report_ <br /> . 188 Ol 7 761 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM 4101 9307 76 30M OlOT osa <br />