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.. .r <br /> STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY DO not fill In <br /> File WITH DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT No. 270820 <br /> Notice of Intent No. State Well No. <br /> _ Local Permit No. or Date Other Well No. <br /> (1) OWNER: Name KPn Enrd (12) WELL LOG: Total depth 210 ft. Completed depth ft. <br /> Address P In Box 5367 from ft. to ft. Formation(Describe by color, character,size or material) <br /> City Stockton zIP9 2 0 - 3 sgDdy soil <br /> (2) LOCATION OF WELL(See instructions): 3 - 6 hard sandy clot <br /> County San Joaquin Owner's Well Number 6 – 18 sdandy clot <br /> .. Well address if different from above 11751 KettlPman Lane 18 – 26 brn clot <br /> Township 3N Range 7E Section 11 26 – 70 clay and saridy brn clot <br /> Distance from cities, roads, railroads fences,etc. Well i5 Qn NE 70 – 118 s11t 5 clot <br /> rornpr of Kiatt1farran and ET,�U 88, 57' F of 88 118 - 126 brn clot <br /> and 100ft, so, west of hme. 126 - 139 all and <br /> 139 - 144 Cos r dv clot <br /> (9) TYPE OF WORK: 144 – 154 rn s d iaravial <br /> New Well & Deepening ❑ 154 - 177 d b lsilt clay some rocks <br /> 11r <br /> Reconstruction ❑ 177 - 3 b tle clots- same brn clot <br /> _ O ("�j -Reconditioning El 8 coarse std <br /> V1 ('SII Horizontal Well ❑ 188 1 brn clot <br /> Destruction ❑ (Describe 198 21 CO d and nea gravel <br /> Aygll destruction materials and pro- <br /> cedures in Item 12) <br /> (4) PROPOSED US . <br /> Domestic — <br /> Irrigation <br /> Industrial ❑ _ <br /> Well <br /> (`0voplQ TestMunici!\�O ❑ 0. <br /> O er _ <br /> WELL LOCATION SKETCH — <br /> (5) EQUIPMENT: GRAV CK: <br /> Rotary ❑ Reverse ❑ No i <br /> Cable N Air ❑ ete (bore <br /> Other ❑ Bucke c rom <br /> (7) CASING INSTALLED". (8) PER TI O — _ <br /> steel IR Plastic ❑ n Ty of o "on or size of _ <br /> From T i . Gage or I <br /> ft f i Wall [. size – <br /> 0 193 .156 - <br /> (9) WELL SEAL: - <br /> Wassurfamsanitarysealprovided? Yes:] No ❑ If yes to depth Sfl ft — <br /> Werestratasealedagailutpollution? Yes ❑ No [R Interval fL — <br /> _ Method of sealing trailSlt mix grout Workstarted 19— Completed 1987-- <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water.if known ft This well was drilled under my jurisdiction and this report is true to the <br /> Standing level after well completion 106 ft. best of my k w dge and belie . <br /> (11) WELL TESTS: Signed �— <br /> 1 1 <br /> Was well test made? Yes C1 No M If yet by whom? —'(WelflSri <br /> Typeof test Pump ❑ Bailer ❑ Air lift ❑ N Thayer Flell Drilllnrs - <br /> Depth to water at start of test_ft. At end of test ft Person,firm.or ro rahonl Typed or pant <br /> Added) <br /> � ress 74817 E Live yak Rc� <br /> Discharge gal/minafter_hours Water temperature Lodi Calif zIP95240 <br /> Chemical analysis made? Yes ❑ No ❑ If yet by whom? CITY <br /> Was electric log made Yes ❑ No C3If yet attachropy to this report License No 391542 Date of Ihis report <br /> IF ADDITIONAL SPACE IS NEEDED, USE NEKT CONSECUTIVELY NUMBERED FORM M oGt33 <br /> DWR 108 IRmr. 12-561 <br />