Laserfiche WebLink
i <br /> STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY Do not fill to <br /> File With DWR DEPARTMENT OF WATER RESOURCES 290901 <br /> WATER WELL DRILLERS REPORT N0. <br /> otice of intent No. State Well No. <br /> Local Permit No. or Date Other Well No <br /> of <br /> (1) OWNER 'dame (12) WELL LOG Total depth ft Completed depth ft <br /> Address ' !e from ft, to It Formation(Describe by color character size or material) <br /> City L ZIP _ <br /> (2) LOCATiOI OF WEL).(See instructions) <br /> Countyflc"Al. Owners Wel!Numberhilt)�Well address if different from abov <br /> Township Rangel<'* —d:�' Section — <br /> Distance from cities, roads, railroads,fences,etc — ?� <br /> (3) TYPE OF WORK <br /> New Well ❑ Deepening ❑ — <br /> Reconstruction ❑ <br /> Reconditioning ❑ \ <br /> ��2 Horizontal Well El <br /> -' Destruction ❑ (Describe <br /> destruction materials and pro- <br /> n\\ <br /> cedures in item 12) <br /> �J (4) PROPOSED US _ ^ <br /> Domestic <br /> Irrigation <br /> Industrial �� ❑ <br /> Test Well ❑ 111 n v <br /> Lmunict "t <br /> er <br /> WELL LOCATION SKETCHt"e) <br /> (5) EQUIPMENT A CRAVM, ACK <br /> Rotary ❑ Reverse ❑ No`CJ Siu <br /> Cable El Aar 1:1et of bore �^ <br /> Other ❑ Buck Red from <br /> to fit = <br /> �/ <br /> (7) C WNC INSTALLED i (8) PERPORATI&s _ <br /> Steel ❑ Plastic ❑ Ty of on or sized r� <br /> From D Gage or n� Tom' ��; t — <br /> It f Wall <br /> t size — <br /> (9) WELL SEAL <br /> Was surface sanitary seal provided? Yes ❑ No ❑ ff ves,to depth ft <br /> Were strata sealed against pollution? Yta ❑ NO ❑ Interval f L — <br /> Method of sealing Work started 19— (,ompieted <br /> (10) WATER LEVELS WELL DRILLERS STATEMEN f <br /> Depth of first water if known ft <br /> Standing level after well completion ft hu u+efl urts ed under ,e 1urrsdicti .and this report t4 tripe to the <br /> g p best of my k �e and belief <br /> (11) WELL TESTS <br /> 0 Was well test mads Yes ❑ No ❑ If vis,by whom Signed (We eller <br /> +De of ten Pump Cl Ballo ❑ A.Idt ❑ NAME SFECTRUM EX RATIO <br /> rpth to water at start of test—it At end of test ft ,(Person firm or corRaration)(T or printed) <br /> ` Discharge gal/min after hours Water temperature Addr,sa 2 B 5 E. MYf2TLE STREET <br /> Chemical analysis made Yes © No ❑ If ye-,by whom City STOCKTON CA Zip 95205 <br /> Was electric log nude Yes ❑ No ❑ If yes,attach copy to this License No 512 2 68 Date of this report <br /> OWR IGO(REV 124M IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM 36 96355 <br />