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(feu ,G <br /> • STATE OF CALIFORNIA �— <br /> ORIGINAL `je THE RESOURCES AGENCY Do not fill In <br /> File with DWR DEPARTMENT" OF WATER RESOURCES r <br /> WATER WELL DRILLERS REPORT 630. <br /> X87427 <br /> i� Notice of Intent No. ' <br /> State Well No. <br /> Local Permit No.-or Date A 9-2 12 6 - Other Well No- '03 <br /> r� <br /> - — <br /> (1) OWNER: Name (12) WELL LOG: Total dept,275_ft. Completed depth 2�LCz ft. <br />' address from ft. to ft. Formation lDescribe by color, character,size or material) <br /> City. Tracy - CA —zip 95376 <br /> - <br /> (2) LOCATION OF WELL (See instructions): <br /> County Owners Well dumber - <br /> Well address if differ t fr allove <br /> I J�� G� - <br /> Township __ r'S • Range 2� Section 19 <br /> Distance from cities, mads, railroads, fences. etc. <br /> I - 73 ClayD- ur-h-Am Ferry Rd . 73 <br /> -_77 C,r a I \\ i, <br /> 77 _- 98 C I a \ <br /> (3) TYPE OF WORK: 1 <br /> New Well XX Deepening ❑ 110 - <br /> Reconstruction ❑ <br /> Reconditioning ❑ 17 <br /> - <br /> Horizontal Well ❑ X79 2 ' <br /> Destruction ❑ (Describe 2 a9,, / <br /> destruction materials and pro- � 4 � . <br /> cedures in Item 12) 2A,512 r- S a n d,--& -�G <br /> (4) PROPOSED US 2 5`f - <br /> Domestic /1255 - 2&Z_,--Fine <br /> Irrigation / 2 6 2 = 275 , Clay <br /> Industrial ❑ <br /> Test Well ,v ❑ _ <br /> MunicipQ. ❑ ✓ <br /> Oder C1 <br /> WELL LOCATION SKETCHl \ - <br /> (5) EQUIPMENT: CRAVt� CK: a r & - <br /> Rotaryr(_p, Reverse 0r <br /> re+s� No „Size <br /> Cable <br /> ❑ Air ❑ et of bore <br /> Other ❑ Bucke aced from <br /> (i) CASING INSTALLED: (8) PER?t%ATIONS: <br /> Steel ❑ Plastic Ix n e Tvp"ffo on or size of r _ <br /> From D' Cage or < t <br /> ft. f 1 Wall t. size _ <br /> i <br /> j (9) WELL SEAL: _ <br /> Was surface sanitary seal provided? Yes CX No C3 If yes,to depth 10 0 0 ft. <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval ft. - <br /> Method of sealing BENTONITE Work started A 1 14 19-&9 CompletI I9— <br /> (10) WATER LEVELS: WELL DRILLER'S STATE.IENT: <br /> Depth of first water,if known ft. <br /> 3 8 ft This e!lu'¢s drilled under nljurisdiction and this report is true to the <br /> Standing level•afterwell completion hest of my <br /> knuuler of and belief. <br /> (11) WELL TESTS: �y Signed <br /> Was well test made? Yes C3 No M If yes,by whom? C (Well Driller) <br /> Type of test Pump ❑ Railer ❑ Air lift ❑ NAME H E N N I N G R <br /> Depth to water at start of test ft. At end ui test ft. 'Person..Firm•,x oxporalion)(Typed or printed) <br /> Discharge gal/min after hours Water temperature Address 3 5 2 5 P F I ANDAIE AVE _ <br /> C:hemi,al analysis made.? Yrs ❑ No M If yr.%by whom? City 0(}EST 0 CA ZIP Q 51 S R <br /> Waselertric log made Yes ❑ No, M If yes,attach cntly to this report License No. 2 9 Q R 12 Date of this rPpOrt C <br /> DWR I89(REV. 12-at5) IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM Sp 96355 J <br /> I <br />