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Svwrr Or CALWORN1A <br /> ORIGINAL THE RESOURCES AGENCY Do -not 01 it <br /> File With DWR DEPARTMENT OF WATER RESOURCES <br /> 'WATER WELL DRILLERS REPORT No. 256525 <br /> tice of Intent No. '� ✓~ State Well No. <br /> Permit No.or Date R �O0 q� .. � �� <br /> + Other Welt No <br /> (1) OWNER Name Twin Oaks Mobile home P JU) WELL LOG Total depth_--oft Completed depth Z-10—It <br /> Address-11303NAddirea-11303 North Highwav 99 from fL to ft. Formation(Describe by color,character size or materfal) <br /> City Stockton California ZIP 12 p - 7 Soil <br /> (2) LOCA'T'ION OF WELL(See instructions) 2 — 15 Sand <br /> county Sari Joaquin Owners Well Number -15. , 30 Clay <br /> Well address if different from above () — 8 Sand, <br /> Township. 42Ahl —Hang _ Section 38 45 Clay <br /> Distance from cities,roads,railmads,fenoes,etc. — 56 Swid <br /> 61 67 Sa <br /> 74 la <br /> (3) TYPE OF Wom-- 7 d <br /> New writ 0 Deepening ❑ — Clay <br /> Reconstruction ❑ U6Sand <br /> Recondltloning ❑ 94 1XI-ay <br /> Horizontal Well ❑ 9 0 d <br /> Destructwo ❑ (Describea <br /> destruction materials and pro- 1 S an <br /> A utLq"!f cedures to Item 12) 2 Gy <br /> (4) PROPOSED US <br /> Domestic <br /> Irrigation d a <br /> Y4 Industxfal ❑ _ 64 Clay <br /> Test Well Q C a <br /> 113 tjJ kf rim <br /> munici _ O an <br /> - Clay <br /> WELL LOCATION SKE'T'CH the) an <br /> (5)EQUIPMENT ( GRA c L — Clay <br /> Sand <br /> Sotary IN I6evene ❑ N i <br /> CAble ❑ Air ❑ e f bore ay <br /> other ❑ Bnc d ram tr <br /> SJ2_f!tjent Plug on the Bottom. <br /> (7)CASING INSTALIXD- (S) P 8 T1 — <br /> steelPkutle Q of fo orsizeof <br /> 04, <br /> From Gage or < k <br /> ft f V size <br /> +1_ 230 <br /> (S) WELL SEAL <br /> Was awfaceswdtary seal provided? Yes(A No © IF yea,to depth O Ft. — <br /> WeresttatA sa Wagamst pollution? Yes 0 No ® Interval ft <br /> Meshed of sealing Work start 19_ Com tete 19___._ <br /> (10) WATER LEVELS WELL R LER'S S A NT <br /> Depth of fiat water,if known IL <br /> Standtnglcvelofterwencompletion Ft Thla me11 1 r r u e!a epo t Trus !o the <br /> A <br /> ee!of S t g n 1te <br /> (11) WELL TESTS Signed <br /> Waswell test ma&P Yes© No W if yes,by whom? (WeliDritier) <br /> ypeoftest Pump ❑ Bader ❑ Airlift ❑ filAM7r, Clark Weu, Inc. <br /> thtosrateratstartoftest ft Atendoftog fL (Person,Fira%orcorporat6om)(Typedorpriated) <br /> Dtxharge gal/min after hours Watertemperature Address 2094 'East Chamter Way <br /> Chemical analysis made? Yes ❑ No in If yes,by whore? aty C t o r+•ir <br /> WaselecMc la made Yes ❑ Wag 1fer,attach to lh1s st License Na Data of this report <br /> pyo Me(R2y saea) W ADDITIONAL ISPACK 19 N9E09D, USE NEXT CONSHCUT1VELY NUMBERED FORM 86 9033 <br />