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STATE OF CALIFORNIA <br /> DUPLICATE THE RESOURCES AGENCY DO not fill it, <br /> Driller's Copy 'DEPARTMENT OF WATER RESOURCES <br /> 'WATER WELL DRILLERS REPORT N0. 252910 <br /> Notice of Intent No. 1 <br /> _ n 7 State Well No. <br /> Local Permit No. or Dale ., Other Well No. <br /> (1) OWNER: Name' '61'�f) n`r <br /> (12) WELL LOG: Total depth ,]_ft.Completed depth 212 ft. <br /> Address <br /> from ft. to ft. Formation(Describe by color,character,size or material) <br /> City_ Trarv , rn !IP 9517p, _ <br /> (2) LOCATION OF WELL (See instructions): 0134 r _ <br /> County San J o a dlg i n Owner's Well Number 18 — <br /> Well address if different from above — 1 f` <br /> Township Ranke ScCtion ' S C? <br /> Distance from cities, roads, railroads, fences, etc. J F C t a t P s 3 — <br /> l1 - r, f.,.I r <br /> 55 - 60 Cla <br /> (3) TYPE OF WORK: C1 4 — - Ei t <br /> New Well [X Deepening ❑ r^' — '1 <br /> Reconstruction ❑ E; <br /> Reconditioning ❑ <br /> Horizontal Well ❑ <br /> Destruction ❑ (Describe — O <br /> destruction materials and pro- <br /> cedures in Item 12) <br /> 7 C <br /> f ' <br /> (4) PROPOSED US <br /> Domestic <br /> Irrigation — <br /> Industrial <br /> Test"1'estO ❑ — <br /> Well ❑ <br /> Munici ❑ <br /> O ler _ <br /> WELL LOCATION SKETCH Ibe) <br /> (5) EQUIPMENT: GRAV , CK — <br /> Rotary YY Reverse ❑ No Si <br /> Cable ❑ Air ❑ It of bore <br /> Other ❑ Bucke ed mm - I <br /> I <br /> (7) CASING INSTALLED: (H) PEI TI S: <br /> Steel ElPlastic n e Ty of fo on or size of <br /> From D' Gage or of _ <br /> ft. f t Wall t. size _ <br /> (9) WELL SEAL: _ <br /> Was surface sanitary seal provided? Yes No ❑ If yes,to depth �r0 ft. _ <br /> Were strata sealed against pollution? Yes ❑ No ❑ Interval ft. _ <br /> Method of sealing Work started E0171FS 1911L Completed 19_ <br /> (10) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of first water,if known ft <br /> Standing level after well completion — This well was drilled under nil/ jurisdiction and this repo j is true to the <br /> ftbest of my knouaed a and belie . `I <br /> (11) WELL TESTS: � <br /> Was well test made? Yes y y Signed --{-\_ <br /> ❑ No If es,b whom? <br /> Type of test Pump El Bailer (Well Driller) h <br /> ❑ Air lift O NAME I <br /> Depth to water at start of test ft. At end of test ft. 'erson,firm,or corporation yped or printed <br /> Discharge gal/min after hours Water temperature Address PEI to U n A I r- A V F <br /> Chemical analysis made? Yes ❑ No EX If yes,by whom? City �1 �T 6r s -C A ZIP Qa 3�I i <br /> Was electric log made Yes ❑ No q If yes attach copy to this report License No. - 1(� <br /> `Y� C'�Q�13 nate of this report <br /> DWR 188(REV. 12-86) IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br /> 86 96353 <br />