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r ►�Ir <br /> TRIPLICATE STATE OF CAUr8RNIA DO 7ZOt !l in T <br /> Owner`s Copy THE RESOURCES:AGENCY <br /> DEPARTMENT OF WATER P10V I C 1� <br /> � RESO1.iRCE9 i.d87 No. 199742 1 <br /> Notice of Intent No. WATER WELL DRILLERS REPO=RT p �p t�t�7�p <br /> Local Permit NJ or Date ��. C%�; yj ENVIR0 Yl ENl a iiu LoT�H- --- <br /> I) <br /> 1 O Tri-Val Iey Growers <br /> .f � <br /> ( � •�W (12;) WELL LOG: Total de,,t1L2-1--St. Depth of completed we117 - 5ft- <br /> Address ') from'ft. to ft. Formation (Describe by color, character, sue or material) <br /> i <br /> City i,—a5 3 5 3 4 1" .-a. (lark brown vei;y fine sandy f <br /> (2) LQCATI9N OF WELL (See instructions); — silt dam�n <br /> Count, $an II 1 o Urn _ MW-•3 - <br /> 4.. Owner's Well Number <br /> Well address if different from above 26200 Nowell Rd. � 7 . ;; 4 ver dark grayish sh brown .: c l aye <br /> Township Range ;horntons5e 1 - silt, damp, medium stiff <br /> Distance from cities, roads, railroads, fences,etc. — ` <br /> �i 9 - 7 very dark graysilt ela <br /> .—moist, very sot <br /> (3) TYPE OF woRK: I - 9 -aark brown clayey -glity sen <br /> I New Well*f Deepening ❑ damp, me um dense <br /> Reconstruction [] t <br /> Reconditioning ❑ 13lu darkyellow brown s1I <br /> ff_CT ay} <br /> Horizontal Well ❑ - — am p. , medlum stiff <br /> Destruction ❑ (Describe — <br /> { destruction materials and _ <br /> 4 procedures in Item lE)_ 13 dark owlih brown sandy it <br /> l <br /> (4) PROPOSED`USE:- <br /> `! - l <br /> Domestic .❑, _ ); — <br /> Irrigation• — <br /> 18 dark brown silty sand - wet <br /> Industrial ❑ ja <br /> Test Well ❑ „ — <br /> J Stock {] <br /> • sand, wet, <br /> E Municipal ❑ - — <br /> ium dense ' <br /> WELL LOCATION SKETCH Oth — -.. <br /> (5) EQUIPMENT: (B) GRAVEL PACK: ` — <br /> Rotary- ❑ Reverse ❑ 'Yes No ❑ <br /> Cabte, [] Air ❑ Diameter of bon:7• <br /> Other Vao Qr Bucket ❑ Packed from 23• to 9` <br /> f7) CASING INSTALLED: (8) PERFORATIONS: — <br /> i <br /> Steel ❑ Plastic MI Concrete ❑ Type of perforation or size of screen -- <br /> { <br /> From To Dia. Gage or Frolli To Slot - <br /> ft. t. in. Wall ft. ' ' ft. size - <br /> il - <br /> (9) WELT. SEAL: - <br /> { <br /> Was surface sanitary seal provided? Yes KI No ❑ If yes, to depth- ft. ? — <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval ft. — <br /> Method of sealing Work` start 19=&7= Completed 19 <br /> (10) WATEk LEVELS: WELL DRILLER'S STATEMENT; <br /> 13 <br /> Depth of first water, if known ft. This!well was drilled under my iuri-vdiction and--this report is tine to the best of my <br /> F led a and belie <br /> Standing level after well completion ft. k,wu s f k Parrish <br /> (11) WELL TESTS: Sic. rED <br /> Was well test made? Yes ❑ No)JD if yes, by whom? (Well Driller) <br /> Type of test €_ Pump ❑ Bailer ❑ Air lift Q NAME E x c e 1 t e c h s Inc. <br /> Depth to water at start of test ft. At end of test '� ft (Person, firm, or corporation) ('Typed or printed) <br /> e <br /> Discharge 11_ jai/min after hours Water temperature Address 41674 Christy . y <br /> Chemical analysis made? Yes ❑ No ❑ If yes, by whom? C,tY� �"�� ^{fly-T����A�j�Zip <br /> Was electric log made? Yes ❑ No)J If }'es, attach copy to this report License No. ate of this report <br /> X�( 1 <br /> DWR 1843 1R>_J7-76l IF'ADDITIDNAL SPACE 15 NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM - <br /> f� <br />