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Customer obtained permit <br /> ORIGINAL. <br /> °r STATE OF CALIFORNIA <br /> File wi#h bWit <br /> THE RESOURCES AGENCY .Do note <br /> DEPARTMENT p ll in <br /> F WATER RESOURCE <br /> 'I Notice of Intent No. S <br /> Local Permit NO. or Date 7 - 3 �. WATER WELL DRILLERS REPORT No. <br /> 168948 <br /> ff State Well No. <br /> l Z) OWNER: Name�j00 r Other Well No. <br /> �+ rman s Water S stella <br /> ��Addres i 2120 Wilcox Road (12) WELL LO(;: <br /> City. Stockton, Calif. fmm ft to Total depth-ft. Depth of completed weiL�l�ft. <br /> ft Formation {Describe by color, character, size or material) <br /> '(2} LOCATION OF WELL rp 95205 _ <br /> County (See instructions): - <br /> f !Well add Owner's Well Number _ <br /> i rens if different from above 1 S RO its <br /> Township Rd. - <br /> � ge Sectio <br /> Distance from cities, roe 70 - 1�fl <br /> ds, railroads,fences,etc <br /> 100 - 107 sapid.4.. <br /> . Cls .;:�;�•-` <br /> (3) ME OF WORK: <br /> f �i <br /> New Well CC Deepening ❑ e `� <br /> z <br /> Reconstruction E2 <br /> Reconditioning ❑ ��. \\J} <br /> i Horizontal Well ❑ <br /> Destruetioa Q {Describe <br /> destruction materials and \ <br /> procedures in item 1,2Y V i <br /> (¢) PROPoSED US - �` i✓� �' <br /> Domestic ' <br /> Irrigationr - <br /> \\, V <br /> Industria] � ❑ � �,. � '�� ,•� <br /> <°• <br /> F WELL LOC Municipal <br /> ATIpN SKETCH Other ♦ k <br /> ('5). EQUIPMENT: e ❑ _��} <br /> (e) GRA PACK: <br /> Rotary Reverse ❑ <br /> i <br /> Cable 0 � NO Si. � .• <br /> Air ❑ meter of bore 1�( <br /> Other <br /> ❑ I: Bucket ❑ <br /> i 7)i CASWG INSTALLED: , <br /> i {8>�PEItFO1tA7IOl\iS: <br /> Steel ❑ Plasti Cont.?ete 'TYI>e ofa <br /> P r��iation 0:S��ze of screcar� <br /> From To Dia. Cog F \ <br /> ji _ <br /> # in. . Wall Toft <br /> L' <br />!9)11WELLISEAL- <br /> C . <br /> Was surface sanitary seal Provided? Yea <br /> j No ❑ If Yes, to dept 1 <br />+Ycre strata sealed against - <br /> ��Po on? Yes [] No ❑ Interva� _ <br /> dethod of se '.��+r�tuull.Ll <br /> 10) WATER LEVELS: Work s <br />)eptb of lust;'water, if Icao 19 Complet - <br /> i <br /> WELL DRILL ER'S STATEMENT: 1s <br /> tarrding Ievel;after well completio Th" sueR rvaa drilled <br /> knowledge acrd beunder my furisdiction and thio report is t <br /> WELj;= TESTS: rue to the heat of mq <br /> ras well teat made? - -SIGNED <br /> Kpe of test :: Pump Q No ❑ if Yes, by whom?of - <br /> Bailer 0 Air lift <br /> i ❑ {We[I Driller) <br /> sch to wac°r at start t it_ M Ca - <br /> At end of tesNAwater er Drl.11inO mal/min'after firm, or <br /> ,hours Water tem S, corporation) (Typed or printed) <br /> remical analysis made? Yes tempera Addres 3Q0 i <br /> ,I ❑ No ❑ If Yes. by whom? City <br /> a, electric lug made? Yea Turlock, Calif. p953$0 <br /> ❑ No ❑ If Yes, attach copy to this report 321252 <br /> NR 1B$ (DEV_7.7st License No. <br /> j . <br /> IR ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY !NUMBERED FORMate of this <br /> i <br /> J ' <br />