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ORIGINAL STATE OF CALIFORNIA Do not fill in <br /> THE RESOURCES AGENCY NO, 22652 <br /> Pile with DWR DEPARTMENT OF WATER RESOURCES <br /> Notice of intent No. WATER WELL DRILLERS REPORT W '' "\ I ,"�-- r"' ,41 <br /> r7 State Nell No.- <br /> Local Permit No.or Date ( 9W Other Well No„Ity/r6-'— <br /> (1 (12) WELL LOG: Total depd)_L-iZft. Depth of completed well--45-9 <br /> A� from fL to ft. Formation (Describe by color, character, size or material) <br /> C1 0=3 Top soil <br /> (2) LOCATION OF WELL (See instructions): eiy <br /> 5-9 Sand <br /> County .San JQa3quJ n _ Owner's Well Number <br /> Well address if different from above9"34 Clla y, <br /> Township 4i _Range R6E Sectio 34r 37 NAA all <br /> Thornton Rd. <br /> Distance from cities, roads,railroads,fences,etc \�' a y <br /> 4mi. North of Eight Mile Rd. , West side ? <br /> =6 Clea <br /> 64--69 \\ San <br /> (s) TYPE OF WORK: �ek ` & shale <br /> New Well X Deepening p 1 t . 0 -Good Good sand <br /> Reconstruction © 200-2Q . B11Aclay & shale <br /> Reconditioning 0 -�12,' = blue sand <br /> Horizontal Well e C ay <br /> Destruction Q (Describe U an <br /> destruction materials �q <br /> procedures in Item 1 �, —2 , ue L+l� /> <br /> (4) PROPOSEDs 230-2Fa ir4W re' s and <br /> Domestic 2 l { 8,�J- Bl Cha <br /> Irrigatiorue � B 6� \Ale <br /> Industria( o <! %-:2360 B'll� ue sand <br /> �t WeR\V ❑.\'�, 0r--3 5 Blue eta <br /> St! )85-390,,, �`ne blue sand <br /> Munici - ,- L ue clay <br /> WELL LOCATION SKETCH Other �"� [] 3 Q 'Q\/ Bluesand <br /> (s) EQUIPMENT: ts> cRA�vl�l'PACK: b� 1� p- $`- Blue clay <br /> Rotary o Revers e No size �� e Fine Blue sand <br /> Cable ❑ Air ❑ ter of bore ' ] Blue ala <br /> t <br /> Other ❑ Bucket p �a� ro O \t 45o - <br /> (7) CASING INSTALLED (B);PERFORetT3 slouvered \ - <br /> SteeIM Plastic C1 C het o Type of pe ti n o ize of ser - <br /> S a <br /> Froin T Dia. r Flo To <br /> ft. fi in. Wall # ft. <br /> 0 45 ST ll 2h - <br /> - <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yes [] No X If yes, to depth, h. <br /> Were strati sealed against pollution? Yes 0 No ❑ Interval* ft. <br /> Method of sealina Work starte 19 Completea 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if know This well was drilled under my jurisdiction and this report is true to the best of my <br /> Standing level after well completion ♦ knowledge and belief. <br /> (11) WELL TESTS: SIG\FD L"12� <br /> Was well test made? Yes Z1 No 0 If yes, by whom? P•G•&E �/ (Well Driller) Tnn <br /> Type of test Pump} Bailer p Air lift p NAME— L'Tlli ;P--Bros Drilling `0- .— <br /> Depth to water at start of test Et. At end of test fta n,fi o ti (Typed orprinterl) <br /> Discharg33 -0 pal/min after ll hours Water temperature <br /> Address 25 od`' '�J. �t�Fhf�`y ` Va. <br /> Chemical analysis made? Yes 0 NoZ If yes, by whom? City Modesto, Cic1 if` Zip�.0 <br /> 1" tric log made? Yes No If es,attach c 290$1�Date of this re rt 2-21-7Z— <br /> ISS <br /> Q y copy to this report License No Po <br /> ISS (REV.7.76) IF ADDITIONAL SPACE IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM 43616-9507-7650M QUAD ai rO6? <br />