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ORIGINAL STATE OF CALIFORNIA Do n0t)W in <br /> THE RESOURCES AGFENCY <br /> File with DWR DEPARTMENT OF WATER RESOURCES No. 185796 <br /> e w of Intent No WATER WELL DRILLERS REPORT State Well No� ,/� /•' rrmit No or Date Other Well NaYi6L06 j- <br /> ( E) OWNER game 46:l' 'e (12) WELL LOG Total depth w Depth of completed welL_ft <br /> address ` from ft to ft Fnrm-ition (Descnbc by color character sue or material) <br /> (2) L CATT N OF TELL (See instructions) <br /> Cnunt� lf�j Owners Well'lumber - <br /> Nkell address if different from above - <br /> Township A62 -Rang Sectio - ` <br /> Distance from cities roads railroads,fences,etc - <br /> (3) TYPE OF WORK 4� <br /> New Well C) Deepening ❑ 1 <br /> Reconstruchon ❑ _ <� <br /> Reco�rtionmg <br /> Horizontal Well ❑ - <br /> Destruction ❑ (Describe - <br /> destruction materials abd <br /> Procedures in Item 12) ` <br /> (4) PROPOSED UfE` — <br /> /1 Domestic ❑. _ ' <br /> Imgahpa ❑ = <br /> //✓/4/ri�'1/ <br /> Industrial ❑ <br /> Test Well ❑ _ <br /> Stock El - <br /> Munimpid © _ <br /> WELL LOCATION SKETCH Other J <br /> (S) EQUIPMENT (8) GRAVEL PACY <br /> Rotary ❑ Reverse ❑ Yes ❑ No ❑ Stze <br /> Cable ❑ Air ❑ Diameter of bole - <br /> Other ❑ Bucket ❑ Packed - <br /> (7) CASING INSTALLED (8) PERFORATIONS - <br /> Steel ❑ Plasuc ❑ Concrete ❑ Type of perforation or size of screen. <br /> From To-_-. Dia Gage-or From TO Sint <br /> fti ft,� m. Wall ftp ft sFr. - <br /> (9) WELL SEAL <br /> Was surface sanitary seal provided? Yes ❑ N'o ❑ If yes, to <br /> Were strata sealed against pollution? Yes © No ❑ Interval it _ <br /> Method of !ealtnE Work 19 Completes 19 <br /> (lo) WATER LEVELS WELL DRILLER'S STATEMENT <br /> Depth of first water if It - - ------ _- __ R ThLr UW11 fled under my turadeetr; and is report u tree to the belt of my <br /> Standing level after well completion k. <br /> kno <br /> (11) WELL TESTS SIGN <br /> Was well test made? Yes ❑ No ❑ If yes by whom? ( tiller) <br /> Type of teat Pump ❑ Bailer ❑ A" hft ❑ NAM SPECTRUM ORATION, INC <br /> Depth to water at start of test �►- At end of test tr (Person,firm,4RZTT.TV. <br /> porab—) (Typed or printed) <br /> Addr� 2825 E. - STREET <br /> ^i+arge �1/min <br /> after---------hours Water tempera STOCKTONr CA- <br /> sal analysis made? Yes ❑ No C3 If yes, by whoma City •. <br /> lectric log made? Yea 0 No ❑ If yes attach copy to this report License No 512 2 6 L-----Date of this report <br /> Dwf: lea (REV 7lei IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECU'T'IVELY NUMBERED FORM <br />