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tiRIGINAL 1 5TATE OF CALIFORNIA DO not fall to <br /> THE RESOURCES AGENCY n� <br /> le with DWR DEPARTMENT OF WATER RESOURCES NO. 083763 <br /> re nr Intent An 1753ba WATER WELL DRILLERS REPORT <br /> State Well No <br /> ! Permit No or Date Other Well No <br /> P�W�NEg Hank Wallenberg01Hw ry (?2) WELL LOG Tota1 dept], 00ft Depth of rnmpleted w fes V 11 from ft to ft Form[tion (Descnbe by color, character size or matenal) <br /> City �R Imo r zipU - any <br /> ops o i <br /> ay, some S <br /> an layers O <br /> t�O�� V �See instructions) <br /> rh U� Owners <br /> WeU Number an <br /> ell address iLdif�rent from above a—,n Clay -Layers <br /> 19 50 T rµnshtp L rian>a Sechr ` <br /> t <br /> Lay <br /> 100 <br /> tant a fn.ue uo <br /> ties roads rltlrads fends,ens,etc JC Wy 99-- 70 r <br /> (3) TYPE OF WORK <br /> i New N ell:] Deepening ❑ <br /> / I Reconstruction 11 — <br /> Q n ReLonditlong ❑ O e <br /> mB Was ins a e on <br /> Hunzonta[ Well ❑ e a m no-t responsible <br /> Destrc ❑ ((Describe3► a g a v g a e <br /> destructlon tun m ttenals <br /> I C�` procedures rn Item <br /> J1 � (4) PROPOSED - <br /> / � � I J Dnntesuc _ <br /> Irnt,[tion ❑ <br /> f� Industrnl O ❑ <br /> Well ❑ <br /> Sim <5 A� <br /> Mumup <br /> \I LLL LOCATION SKETCH Other ❑ — <br /> EQUIPMENT (6) GRAV'15 ACh — <br /> tan Reverse ❑ Stre <br /> 1 ' <br /> Air ❑ r of bore l� <br /> Other C] Hu,l[t E] )m 0 t 100 _ <br /> l (A%I1 <br /> NC I%STALI 1-11 (8) ERF <br /> el ❑ PI Istat N ( a T+pe of pe a ur re of SE.reerknFrom To Da , r G1 F To — <br /> ft ft In <br /> %V L11 ft fIt st > <br /> �+ 10 <br /> WELL SEAL - <br /> Was surface sanitary seal provided? )es ❑ No E] If yes to depth 5o ft — <br /> ere stru-1 sealed .1galnst Loetme"les C] NoM Interval It — <br /> 30422 <br /> thcrd of seahn C Work started <br /> 0) WATER LEVELS WELL DRILLERS STATE\IE\ <br /> Depth of $rat molter, if knomri ft This well war xdo <br /> rrr!under m r.na! tr u , <br /> v d ,.r..n r. ro r the Lrrr f my <br /> indml, 1 sel after µelf completion _ ft nowledge i eh./ / <br /> 1) WELL TESTS }}��L�y -- <br /> ,+ atll 1csl nrtdt' les C] No [X If yes by uhom� P era del `L�l f]!mr <br /> Trhe r f tt+t Pump LD H-ktler E) Air left [3G Inc . <br /> lith In µit,r it +t tri rrr test It At end of lest ft i hr r ! r ,a.d, .� <br /> 3z45d"�. '�Ftone'' T'r'ee Rorid <br /> 4trt.._ _ ctl'nuu after lw%jrs N% tier Umptrahtre Addt„t--Oakdale r Cal y i . 95361 --- <br /> +l autl+,r, mrdt' I- � \r ❑ if +t, b+ [thom1 (;I5 ._.,—_�__ J10/23/.?g - <br /> , <br /> 3// 7 <br /> 1 tin. I c melt' lt+ ❑ \u It +r, alt,t It , p. t 1111. rtp.,rt Lrtt osc .r 333114 10 <br /> Iaa NIV 7 76 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />