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STATE OF CALIFORNIA <br /> DUPLICATE THE RESOURCES AGENCY DO not JiII in <br /> Drillerrs COPY —J--DEPARTMENT OF WATER RESOURCES <br /> r� WATER WELL DRILLERS REPORT N0. 252910 <br /> Notice of Intent No. I State Well No. <br /> 7 <br /> r " <br /> Local Permit No. or Dale —247 1.1, Other Well No. <br /> (1) OWNER: Name (12) WELL LOC: Total de pili <br /> Address I 23J—ft.Complclesl depth 1(1 ft. <br /> from fl. to ft. Formation(Describe by color,character,size or material) <br /> City Trdryy, Ca ZIP _ 1 <br /> (2) LOCATION OF WELL (See instructions): 1�� t- — <br /> County San J o a m g i n Owner's Well Number 18 21 Gra�pl <br /> Well address if different from alx)ve — 35 <br /> Clay <br /> Township Itange Section 3 fI - C Craypl <br /> Distance front cities, roads, railroads, fences,etc. C — � 6 / <br /> 46 55 G <br /> 55 - 60 C111v <br /> (.3) TYPE OF WORK: 64 — `• <br /> New Well Q Deepening ❑ 7 F' — ') <br /> Reconsiniction ❑ c o "" C l <br /> Reconditioning ❑ <br /> Horizontal Well ❑ PC — <br /> Destruction ❑ (Describe — jnkl <br /> destruction materials and pro- ii <br /> cedures in Item 12) 17f <br /> (4) PROPOSED US _ <br /> Domestic <br /> Irrigation <1 <br /> Industrial O ❑ _ G <br /> Test Well ❑ <br /> Munici ❑ <br /> ter <br /> WELT. LOCATION SKETCH e ibe) — <br /> (5) EQUIPMENT: GIIAV CK: — <br /> Rotary ( Reverse ❑ 1 No Si <br /> Cable ❑ Air ❑ net of bore <br /> Other ❑ Rucke a ed mm JA — <br /> I <br /> (7) CASING INSTALLED: (b) PEI TI S: _ <br /> Steel ❑ Plastic Q(I n e Ty of f-)on or size of O From 'I D' Cabe or of — <br /> ft. f I Wall <br /> (9) WELL SEAL: <br /> Was surface unitary seal provided? Ycs W No ❑ Ifyes todepth Taft. <br /> Were strata sealed against Ix4l tiun? Yes ❑ No ❑ Interval _fl. II`` A <br /> Mcthexlofxaling Work started rCL_ �S 19t)rt Completed 19__ <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water,if known fl. <br /> TINS well was drilled under mq jurisdiction and this re f)o is true fo the <br /> Standing level after well completion __ Z It. 1vst of m y knowled and lxdie <br /> (11) WELL TESTS: Signed <br /> Was well lest made? Yes ❑ No Ek If yes by whom? (Well Driller) <br /> Type of test Pump ❑ Railer ❑ Air lift ❑ NAME <br /> Depth to water at start of test ft. At end of test ft. 11cr- firm,or aprlwration 'ylxd or printed <br /> Discharge gal/min after hours Water temperature Address--H26.. 2 r I A 11 n I E A V F <br /> Chemical analysis made? Yes ❑ No EX If yes,by whom? Cily t.l F�T Q �C ZIP d 9E' <br /> Was electric log made Yes ❑ No a Ifyes attach copy to this report LicenseNn <br /> 13 D:dv of this report 9 g F. <br /> DWR 188 (REV. 12-e9) IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br /> 96 96355 <br />