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'ORIGINAL, STATE OF CALIFORM IA Do not fill to <br /> THE RESOURCES AGENCY NO. 120338 <br /> File with DWR DEPARTMENT OF WATER RESOURCES <br /> LP,n—ml <br /> t No NATER WELL ]DRILLERS REPORT <br /> State Wen No <br /> o or Date Q¢uQ f <br /> Other Well No <br />,(1) OWNER me Naric (12) WELL LOG 'Total depth ft Depth of completed well 245 ft <br /> Addres 184562-. 1'i p. V 8 from ft to ft Formation (Describe by color character size nr material) <br />,c,, LoCkeford, Ca, _. _�.—. zip 0 - 6 Top Sol <br /> (2) L(�CAT�p N OF,WELL (See Instructions) 6 - 20 Me rn. clay <br /> County San tToagjain Owners Nell Number 20 - 23 Sand Hole <br /> �4ell address if different from above Same 23 - 5 0 San y� rn. clay <br /> uwnshtp T4N Range R7E Sectio - Med. r . <br /> Distance from cities roads reilmads fences, etc 73 - II <br /> 1 - 131 sahu�y, brin. <br /> clay <br /> • • miand <br /> • e <br /> (3) TYPE OF WORK ° <br /> New Well ❑ Deepening ] ±5��176 Sandy • <br /> clay <br /> Reconstruction ❑ - , <br /> nk Clay <br /> :142 elay <br /> Reconditioning CD - <br /> Horizontal Well L 4r. 215 Med. brn. elay- <br /> Destruction 0 (Describe - Silty <br /> destruction materials and <br /> procedures in Item 12) - - _ <br /> sand <br /> (4) PROPOSED USE 236 241 Gemented Eeek 1"- <br /> Domestic $) - - <br /> Irriaation © End <br /> Industrial ❑ - <br /> Test Well ❑ <br /> Stock 0 - <br /> Municipal ❑ - <br /> WELL LOCATION SKETCH Other - ❑ - <br /> tS) EQUIPMENT (6) GRAVEL PACT{otary Reverse C] les ❑ \o ❑ Size <br /> C.ible Air ❑ Diameter of bore _ - <br /> )ther ❑ Bucket C Packed from ---- _ tu__-__---­fL - <br /> 7 r CASING INSTALLED - (8) PERFORATIONS - <br /> Steel Plastic ❑ Concrete ❑ T)pc of perfnratfon or slae of scorn - <br /> Froin To - Dta Gage or From - To Slot - <br /> ft ft In Wall ft - ft- size <br /> g Casi g WWC Kia-- - <br /> (9) WELL SEAL 7 ' �..,pQ - <br /> %V.ts surface sanitary seal provided" Yes{y No E: If )es, to depth _ft <br /> W ere strata sealed against pollution" Yes ❑ No N Interval 4r <br /> Method of sealing Work started 19 Completed-19_ <br /> ( 10) WATER LEVELS 131 WELL DRILLERS STkTE\fENT <br /> Depth of first water if known -- -- --- - ft This well miss d led under my turisd ton and the.= repurr is true in the best of my <br /> Standing level after well completion- 108 g knowledge an Ire <br /> W(ll) WELL TESTS Sic\en <br /> li4 is well test made" Yes E: No r If yes, by whom' IWell Driller) <br /> Tvpe of test Pump ❑ Sailer ❑ ALF lift ❑ NAME Goehrin pill Om Irri • <br /> Depth to water at start of test k At end of test ft f Person firm or corptratmon) (Typed or printed) <br /> Address <br /> r harge�_gal/rain after hours Water temperatuze P•0 .BOAC 113 <br /> 95237 <br /> , <br /> ucal analysis made Yes C] No ❑ If yrs, by whoma Lockeford, Ca. 7City P <br /> ms elettne Ing rnade% Yes ❑ No ❑ If res ittach copN to this repnrt License No_2 77491 mate of this report Aug y 16, 19 8( <br /> DWR 188 1REV 7 715) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />