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., .. .., . r..•aa. 01 ^ , � Wr ..,.�: rVKNIA Do not VIII in <br /> File with DWR THE RESOURCES AGENCY EPARTMENT OF WATERRESOUR !S N0 , 227012 <br /> vo leo of Intent Nn. WATER WELL DRILLERS REPORT <br /> Surto Well No, <br /> f Permit No. or Date 81 W 55R Other Well Noo/SnG,cle <br /> ( 1 ) OWNER : Nome " lV a C o ( 12 ) WELL LOG ; Total depth cri 1y colo , epthchar of completed walt_rfal) <br /> Addrea McKinle front R. to R. rornatian ( Describe br mdor, cnamcmr, alae ..r matadal) <br /> City Tench mn kalif Zip 6 Tonsoll <br /> ( 21 ) LgCATION OF WELL ( See instructions ) : 9 H <br /> Coon an Joaquin Owner, Well Number S <br /> and <br /> Well .address if different fine above 15' _ 21 Clay <br /> Tmvnshlp Range cactio 2 ir 28 Sand <br /> Distamoa from cities, mods, mtimads, fences, etc. & 33 � 1a <br /> 33 36 nand <br /> � 1ay <br /> an <br /> ( 3 ) TYPE OF WORK : „ay <br /> Now Well dr, Deepening ❑ F oarse sand <br /> Z Reeonstmction ❑ ay <br /> Reconditioning ❑ _ oarse san <br /> Ha.i:onmf Wen ❑ ay. <br /> Destrn tion ❑ (Describe = r e sand <br /> destruction materials end <br /> Procedures in Item 12 )' <br /> � oW ( 4 ) PROPOSED USE_t — <br /> <3 - Dnmestic _ CK _ <br /> Irrigation p K - <br /> Indus Mal p er wag ingtalled on <br /> O thick -Ual I and I am not responsible <br /> Test Well ❑ '• ? rt <br /> Stock 11 <br /> Municipal ❑ seal- -or casjLng . <br /> WELL LOCATION SKETCH Other p _ <br /> ( 5 ) EQUIPMENT$ ( 8 ) GRAVEL PACK: _ <br /> Rotary []C Reverse ❑ Yes Q{ No p Size pea — <br /> Cable ❑ Air ❑ Diameter of bore it — <br /> Other p Bucket ❑ Packed from 5o ro 1 J 5F _ <br /> ( 7 ) CASINC INSTALLED: ( 8 ) PERFORATIONS: — <br /> Steel ❑ PlastieJ[] Concrete ❑ Type of perEOrson or sire of screen — <br /> From To Dia. Gage or From To Slot <br /> (t* ft in. Wall ft. ft. size <br /> n — <br /> y <br /> ( 9 ) WELL SEAL: CC �� <br /> Was surface sanitary seal provided? Yerx[1 No ❑ If yea, to depth�f[. <br /> Were strata sealed against pollution? Yea ❑ No IAC Interval R. — <br /> Method of sealln Work started 19_ Completed 19_ <br /> ( 10 ) WATER LEVELS : WELL DRILLER'S STATEMENT <br /> Depth of first water, if known a This well was dr ode Z4 ,4DA <br /> o <br /> Standing level after well completion �� ' R, knowledge o ell . 1e r m ; ore is true m the bee at my <br /> ( 11 ) WELL TESTSi STONED <br /> Was well test made? yo ❑ 614t If yea, by whom?Type of test Pump ❑ EaRer ❑ air lif, ❑ NAME Panaro well UrInc . <br /> Depth to nater at end of tent ft. At end of tele a Persn num, or carPoragnn ) ( Ty r ptintea) <br /> Discharge ^aUmin after haum Water temperature Address 31450 �' . icons freed <br /> , analysis made? Yes ❑ No ❑ If yes, whom? Ci �i <br /> electric <br /> P 95361 <br /> eleeMa Ing made? Yes [I No C] If yes, attach copy to this report License <br /> Oakdale , jalif .aense Na. 333114 nate of this report g 9 8 1 <br /> OWR 188 ( REV. 7, 76) IF ADDITIONAL SPACE 15 NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />