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TRIPLICATE STATE OF CALIFORNIA �i Do not ill in <br /> OwnePsCop�r THE RESOURCES AGENCY � <br /> DEPARTMENT OF WATER RESOURCknV 1 c' i98 No. 199741 <br /> Notice of Intent No. WATER WELL DRILLERS REPORT <br /> 87-2966 ENVIROMENTAO"MrLAC W <br /> 1—cal Permit No. or Date r-. <br /> T SGi�Y��,�ESell No. In " — <br /> (1) OWNER: Names Tri-Valle Growers (12) WELL LOG <br /> P.O. Bax 1211 Total deptt2 _ft. Depth..f completed6_ft, <br /> Address from ft. to ft. Formation (Describe by color, character, size ur materia) <br /> City Modes O, Z;p - <br /> c L a�ql�T n WELL (See instructions): MW-2 - <br /> read basereck <br /> count 0ffgj jlI <br /> �„'VAjU•ber <br /> -tell address if different from above i 11 �( — <br /> CA <br /> Township Range Sectio — <br /> Distance from cities, mads, railroads, fences,ate. — gral O o s e <br /> Very dao grayish brown silt <br /> clay. damp, stiff <br /> (3) TYPE OF WORK:New Well X) Deepening 9 - 7 very dark brown silty clay, ver <br /> Reconstruction o - moist stiff <br /> Reconditioning ❑ — <br /> Horizontal Well ❑ 19 - 9 very i s11 row_ s I t <br /> Destruction ❑ (Describe — a , mottled red, amp () wet <br /> destruction materials and <br /> procedures in Item 12) — Stiff <br /> (4) PROPOSED USE: — <br /> Domestic ❑ — <br /> (Mup 11ty sand, wet, loose <br /> Irrigation ❑ _ <br /> Industria[ ❑ -26- -s- 22 dark ye-11owish brown silty— <br /> Test Well [] _ <br /> sand, wet , medium dense <br /> Stock ❑ — <br /> Municipal ❑ <br /> WELL LOCATION SKETCH y v othRonitari xp — <br /> (5) EQUIPMENT: (6) GRAVEL PACK: — <br /> Rotary ❑ Reverse ❑ Yes IN No p Size — <br /> Cable ❑ Air ❑ Diameter of bore CC75 — <br /> Other ❑ Bucket ❑ Packed fromrJ to fit. — <br /> (7) CASING IN ALLED: (B) PERFORATIONS. — <br /> Steel ❑ Plastic ❑ Concrete ❑ Type of perforation or size of screen <br /> From To Dia. Gage or From To Slot — <br /> ft. ft, in, Wall ft £t. size — <br /> .r10 0.02 <br /> (9) WELL SEAL: <br /> Was surface sanitary seal provided? Yes ER No ❑ If yes, to depth 9 ft. <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval ft. — <br /> Method of sealine Work star[ I9 Complet 19 <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water, if know ft. this u;e22 was drilled under my jnrisdietion and this report is trite to the hest of mit <br /> Standing level after well completio ft. k—wledge and belief. <br /> (11) WELL TESTS: SIG- FD Kent Parrish <br /> Was well test made? Yes ❑ No [] If yes, by whom? (Well Driller) <br /> Type of test Pnmp ❑ X Hailer 0 Air lift ❑ NAME— <br /> FxCpltprh - Inc <br /> Depth to water at start of teSt ft. At end of test ft (Person, fine, or corporation) (Typed or printed) <br /> Discharge naI/min after hours Water temperature Address_ _ 41674 Christy_ St - <br /> Chemical <br /> t - <br /> Chemical analysis made? Yes ❑ No If yes, by whoa,? City_ /� /t �Ft r e m fl t C A q Q Ci 3 8iipt� p <br /> Was electric log made? YesF) No If Nes, attach copy to this report License No._ 464 324 Date of this report <br /> DWR 188 (REV. 7-76) IF ADDITIONAL SPACE IS NEEDED- USE NEXT CONSECUTIVELY NUMBERED FORM - <br />