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} <br /> *AL STATE OF CALIFORNIA Do not fiU to <br /> THE RESOURCES AGENCY <br /> Ah DWR DEPARTMENT OF WATER RESOURCES No. 47954 <br /> e of Intent No, _^ WATER WELL DRMLERS REPORT State Wen No <br /> "-ririit No or D.-_22-- 2W Other Well No <br /> (1) OWNER Ya Gu Chamberlain Cont. II Z2 WELL �.�r�� <br /> m 1 � LOG Total dcptlGG]._ft Depth of completed wei1.22n.fL <br /> Add 10366 S . Flynn well for Joe Tost from ft. to ft. Formation (Describe by color character size or material) <br /> City_ evermore CA. zip, a 10 TOP soil__ <br /> { Laz�oa$FijNKELL (See tnstructrorts) 11- 21 Clave <br /> County Owner s Well Number <br /> }Sell tiddress if deferent from lbove 25... 27 <br /> \ eand <br /> T„wriship Rants _ Sectio <br /> Distance from cities mads railroads, fences etc <br /> 60 Clay <br /> 60- 6 \ Sand <br /> 6 Cla <br /> (3) TYPE of WORK. 849100 clay & shale <br /> New Well CX Deepening ❑ IMNa44 Clay <br /> Reconstruction ❑ 1 Gla y & shale <br /> Recondttranmg Q 157- 159 1. Sand <br /> Horizontal Well 070 -Shale <br /> Destruction 0 (Descnbe C <br /> destruction materials <br /> procedures to Item _Lpp <br /> (4) PROPOSED 1 <br /> Domestic ` <br /> 1 4 la <br /> Irri¢attori</'� \ 1 \ � ^�nd <br /> Industnal ❑ 11 " `-'C la <br /> 'Test Wen ,v r ❑ `.. - 21 Gravel <br /> stoo 2 `\ = Clay & shale <br /> WELL LOCATION SKETCH Other 4:� ❑ <br /> (5) EQUIPMENT (6) GHA PACK <br /> _ � s <br /> Rotary [- Reverse Nn't Size <br /> G ible Li Air © witrseter of lure <br /> Other ❑ Bucket 0 ltr�r GS1—tt �•'\ ` — <br /> (7) CASING INSTALLEDr'� (87"1P>rRF0R `ihand cut <br /> Steel ❑ rliisacFf] C �iR Type of pe#Prt onyizc of screery� ^ <br /> From Tc -- Dta r Fr5& �1 <br /> fL fli U, Wall t��`�� V ft ii sty — <br /> 0 2 160W 1 22 v _ <br /> (9) WELL SEAL. — <br /> Was snrflce sanitary seal provided? Yes [X No ❑ If Yes, to degth 50 1_ft <br /> NVere strata sealed against pollution? Yes ❑ No ❑ Interval h <br /> Meduad of seaLn Werk start19= Completed 19 <br /> (10) WAFER LEVELS WELL DRILLER'S STATEMENT <br /> Depth of first water if known ft Thur well u.aa drilled under any )earisdiction and thea report at true to the best of my <br /> Standing level after well completion ( ft knowledge and beliefA �J <br /> (11) WELL TESTS SIGN <br /> W,ts well test made' Yes ❑ Nn 't If ves by whom' (Well Driller) <br /> Type of test Pump ❑ sailer❑ Air left 0 NONE nnings Bros. Drilling Co. Inc. <br /> Depth to water at start of test ft At end of test fr (P firm or rnrporanon) (Tvped or panted) <br /> llachaMe�_ ZLl/nun after_ borers Water temperature Pelanc a e Ave.- /� <br /> rsl arial>'is <br /> made? Yes M No� If yes, by whnen= Ctrl' Modesto2 CA • i�,50 <br /> t � <br /> a,tn• krK m,ide? Yes C) No If>e attach copy to this report License 'ifs, --mate of thu report _17—f r , <br /> DWA 188 (HEV 7 7e) IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM a.+s-seoserasemQUAD(Dr oaP <br />