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RIGINAL STATE OF CALIFORNIA Do not fill in <br /> THE RESOURCES AGENCY n� <br /> tile with DWR DEPARTMENT OF WATER RESOURCES NO. 097938 <br /> 1p,of intent No WATER WELL DRILLERS REPORT <br /> 8 1�122 State Wel] No <br /> Permit No or Date Q'�SQ2✓ <br /> Other Wel]No <br /> WNER \4n,e 11lbertha DeBoer (I2) WELL LOG Tota,d,,O,- Z2ft Depth of completed wen-2 Eft <br /> ddress 13731 4. west Ripon nd, fmm ft to ft Formation (Descnbe by color character, size nr matenal) <br /> i� 1pon, a 1 r 21p 3.1 _ <br /> 2) LOCATION OF WELL 4- 16 Sand <br /> -"an J (See instructions)aunty_ uLn „ Owners Well Number _ C <br /> e]I address if different from above 24- 36 `land <br /> Timnship Ranl Sectio 36- 40 -lay <br /> istance from (dies roads railroads fences etc N. E. Corner Of 0- 48 d and ravel <br /> -)--ck gone and W. Ripon Ltd, 8- 5 � <br /> an <br /> (3) TYPE OF WORK ay <br /> New Well IS Deepening ❑ Qanqy clay <br /> l �EI Recunseruchnn ❑ -- e1 <br /> t <br /> Reconditioning ❑ - <br /> �� Horizontal Well ❑ - <br /> Destruction ❑ (]Describe196 <br /> destruction i vaenaI tj <br /> procedures in Item Y\ ue t-` x <br /> (4) PROPOSED r0 <br /> 1 Domestic - <br /> ALJ Irns,ati"n $1 <br /> _ <br /> Industrial ❑ - <br /> T Well ❑ <br /> SUrc - <br /> W Mumcip <br /> \t LLL LOCATION SKETCH Other ❑ <br /> efy r <br /> (5) EQUIP\IE%T (6) GRAV ACK /�-Jpl And I am not responsible <br /> �utary ❑ Hr+enr ❑ ❑ Nu Stze <br /> ible iy� kir ❑ r of bore - <br /> Other ❑ Hatket ❑ oro t - <br /> ) CASING INSTALLED (8) £RFORATIN� - <br /> erl Plastic ❑ C4I e T)pe of pe a or Wze of scree - <br /> IN <br /> From To Dia Ga Fr To - <br /> ft <br /> It to Wal] ft ft t <br /> WELL SEAL - <br /> as surf ict s Ind irs nt 0 provided" les ❑ No R If +es, to depth ft - <br /> "etc str It i sealed agamst pullutwO Yes ❑ No 2 Inten nl ft - <br /> ethod of sealin \\ark started -l t 1 rnl 3 _ __1 <br /> I <br /> 10) WATER LE,ELS WELL DRILLEH h NI ',I! \1} \i <br /> Depth of -first +tater if knnu ft This ur11 uu., &.1 1 , Ll <br /> tandmy, ]e+el after well completionl.noti <br /> ft ledjrJ'f <br /> 11) WELL TESTS <br /> 15 "t 11 tt.t midi° les ❑ No 5t If tes by Wham' t,t. 1 Ir <br /> Type of test Pump C] Hailer ❑ Air lift El Panero—n el i JriX rit ; 1 riC._ mm T <br /> Depth to N it,r it dirt of test—ft At tad r.f 1­t—ft 1+ hmI .i A. 7 .,f <br /> �dar1,, _ L Cone .ret, rio.l�+ <br /> hargr s 11 min "flee hours N d1 r 14 nIl t r irlih v_ -— I r, <br /> tit, Oakdale, ..alif . 4531 <br /> vicil anrlytn uin11' lr, ❑ \u ❑ If )r+ b) Nhnn+ —313114 6�j <br /> Ly tn. lit, w«li' llsl) \u U ,4. Atli fi I.t1 16i it t•it I . I.rN 3'"14 Iia. t +e .1 3��`�dk <br /> 1B8 IREV 7 76 IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />