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<br /> ' ► 4 STATU OF CAUFORNIA
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<br /> File with DWR THE RESOURCES AGENCY �E 216063
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<br /> DEPARTMENT-OF WATER RESOURCES No. 215 0 6 J
<br /> ce of Intent No. WATER WELL DRILLERS REPORT State well No f �, ay
<br /> Al Permit No.or Dale Other Well
<br /> NO.
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<br /> (l} 0W'1411: Nam C_2M H I "1 ` v V r 1r (12) WELL LOG: Tom]depaUL Ft•Depth of completed 19-a-,uft.
<br /> ' Address t 2200 P o w e l l St from ft. to ft. Formation (Describe by color, character, size or matortol)
<br /> City Emeryville CA Zip 94x08 - 23 ow and clay
<br /> (2) LOCATION OF WELL (See instructions): 23 32 Sand
<br /> Gaunner s Nell Number 32 - -- 4 0 Silt L C1 d
<br /> Wall addrtss if different From nbo 4 0 - 5 5 San d
<br /> Townsb1 1 N re 6 E sacHo 55 -- 62 S i l t y &`1( y
<br /> Distance from cities,roads,ruilrnnds,fences,etc 62 5t -
<br /> ' 14 ` 112 S i' &, C I a y
<br /> * anSilt
<br /> (3) TYPE OF WORK: ,-�/'
<br /> ' New Wall ($ Deepening❑
<br /> y
<br /> Recorutmctimr ❑ � j
<br /> Reconditioning
<br /> Horizontal Welt ❑, f tom •—
<br /> ' e e map attached Destruction❑ (pescribe
<br /> dentruclinn mnteriols anff
<br /> procedures In Item 124,1'
<br /> (4) PROPOSED U
<br /> 11."e,
<br /> 3f/ IAI 3
<br /> ' Domestic
<br /> Irrigation � Lti ❑ 1`�
<br /> Industrial ❑ �,)�."
<br /> TesI1�e11 ❑ '4y�� � rL
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<br /> hiunfe,pol ❑ •� ��\ �,
<br /> WELL LOCATION SKETC11 `\,\pther
<br /> ' (S) EQUIPMENT, (0) GRAVE[, ]'ACK: �.,� •�� ��i) _ _
<br /> Rotary IX Reverse ❑ � ho❑�`; Siz�
<br /> Cable ❑ Air ❑ v D'ujl ,�K of
<br /> Other �o ` -
<br /> ' ❑ Bucket {] Pe1cf�2ckirom..,,-,_ �6
<br /> (7) CASING INSTALLHI)t (8) FjAFOIiATI[fi�
<br /> Steel® Plnstic [] Coner9,1i Type of perfoCdtio#.or siid of screen
<br /> From To ,Iiia. Gng'tl�o r• Fro ,, 1ji o ,$o .4, ( Q
<br /> ' ft. ft '•rn, Wall ft. ''`a ft. t 'tidue
<br /> 0 12 X6',5 8 , 250 _
<br /> N•.r 110
<br /> (t)) WELL SEAT.,t
<br /> Was surface sanitary seal provided? Yes EX Pio C7 If yes, In depth_LJD-9__ft,
<br /> NYem strata sealed against pollution? Yes ❑ No❑ Interval it.
<br /> ' hfathvd of saalin Work stnrta - p Gorn lets - 1$
<br /> (10) WATER LEVELS: _!_.�'. WELL DRILLER'S STATEMENT. .
<br /> Daptb of first }voter, if known_.;_, `,�� ., .._.. tt• Thit weft rMl=
<br /> J fnrisdictien rtyd this report is lane to the Lest of mIj
<br /> Standing level after well completion_ ,ft. knotuiedge ,
<br /> ' (11) WELL VESTS:, � •.1 SIC,vp
<br /> Was %veli test made? Yea ❑ No $S If yes, b wham?-] Yell er)
<br /> Type of test Pump Q, Bslltr 9,; e`. i Air]eft© INAM1<'_ Diamond 6012 Drill i n g , Inc .
<br /> •
<br /> t_ ` - _
<br /> Depth to tivater at star of fast �;'�' tit.'v At Tend,of test - fr Person,firm,or corporation) (Typed or printed)
<br /> ischargc - gal/trot ter oui! •r tiV'ier�tamparatur Addjcss 5 6 Petunia Lane
<br /> I -� )f—A city Palo Cedro , CA ,lp 96073
<br /> micnl analysis made? 1YjvQ NO If ye4,.§y iCom
<br /> electri-10 made? �l<s'�. 'S�ti'y] 1 •4d„ntta�h4c�gpY to this report License No. 512�p 6 _ Date of this report 10-30-87
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<br /> to© tnev.v7ar IF gD�17"I)ON/� �, 1'P�E IS NEEDED. USE NEXT CONSECUTIVELY NUMBERED FORM 4
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