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r <br /> t <br /> IRIGINAL STATE OF CALIFORNIA Do not#U sn <br /> THE RESOURCES AGENCY <br /> File with DWR DEPARTMENT OF WATER RESOURCES No. 216161 <br /> e <br /> of Intent No WATER WELL DRILLERS REPORT state Well No ` <br /> erm+t No or Date Other Well Na <br /> L <br /> OWNER Name Baxter (12) WELL LOG Total depth 9 0 ft Depth of completed welt 8 7 ft <br /> s <br /> s P O _BOX 1 7 2 8 ± from ft to ft Formation (Descn'be by color character sae or material) <br /> ti t) C5t6cktorl tA' zip 95201 0 - 30 Dark Brown Dense Clay <br /> t <br /> ) LOCATION OF WELL (See instructions) 30 - 35 Dark B l u e r e e n , dense clay <br /> ont) S-anjoaquln w, <br /> _OnersWellNumber Os-6B 35 - 40 Gra s nd , Bluegreen , Dense <br /> H ell address if diflerent from above S S t o c k t o n & Church - clay <br /> t­htancenbbip 1 1 N Range 6 E Sectiii 40 - 50 Sand <br /> from cities roads ra+lroadb fences, etc 50 7_68 D u green , dense C a y <br /> 68 - 87 Sa <br /> ar uegeen , dense clay <br /> (3) TYPE OF WORK <br /> See map attached New Well)M Deepening ❑ - <br /> Reconstruction ❑ <br /> Reconditioning ❑ 7 - <br /> Honzontat H ell ❑ - <br /> Destruction ❑ (Debcnbe (1 <br /> destruct+on materials <br /> procedures to Item 12t <br /> (4) PROPOSED U - �J <br /> Domestic - %\ <br /> Irrigation ❑ <br /> Industrial \��\ ❑ .�^ <br /> \ �\ <br /> Stock \\ Q. 775 <br /> jMunicipal',, ❑ - `� <br /> WELL LOCATION SKETCH Other MW - <br /> EQUIPMENT (6) GRAVELS\RACK <br /> clary MX lieverse ❑ Yet` No ©" size <br /> Cable ❑ Air ❑ �ir�+q�er\of bore 10 5 1 <br /> t . A <br /> cher ❑ Bucket ❑ Pacl[e�ltrm_ 6 4 to-',.i fl �� - <br /> 7) CASING INSTALLED �; (8) PERFORATION \� - <br /> steel ❑ Plastic E] ConcArts,�� T)pe of perforapm or size of screen - <br /> From To Dia Cage-o From" To <br /> Slot' - <br /> ft ft `In Wall ]It `�. ft 'I size - <br /> V y „ - <br />(9) WELL SEAL <br /> Was surface sanitary seal provided? les M No ❑ If yes to depth^64 6—ft <br /> Llb� <br /> trata sealed 'igainst pollution" Yes ❑ No [D Interval ft <br /> of sea4n Cement Grout Work started <br /> Complet - 18 <br /> (10) WATER LEVELS WELL DRI ER 5 STATENIENT Z <br /> epth of. first water, if know rt R This well w n!!e rider inn ,u nsdictton and this report to true to the beat of Trig <br /> landing level after well compietio*; <br /> ft knowledge a be eJ <br /> 11) WELL TESTS SlcNen <br /> Was well test made' Yes ❑ No In if )es, by whom> (Well Driller) <br /> fep <br /> E]of test Pump Bailer ❑ Air lift ❑ NAME D Inthto water at start of test -_ft At end of test ft (Person, firm, or corporation) (Typed or printed) <br /> Urge__ cal/min after hours Nj ater temperature Address 10556 Petunia LN <br /> p,ro) Cal analysis made> yes ❑ No Qp If yes, by whom> C+ty d 0 C/et C A - --Zip p <br /> w- <br /> electric log made> Yes ❑ No Q4 If)es attach copy to this repnrt License No 51 406 ate of this repol' .-,4- 1 -$9 <br /> 168 iREv > 761 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br /> I <br />