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ORIGINAL THE <br /> OF CALIFORNIA Do not fill If, <br /> 7HE RE50JRCES AGENCY <br /> File with DWR 4PEPARTMENT OF WATER RESOURCES NO. 129572 <br /> 4 of Intent No WATER WELL DRILLERS REPORT state Well No <br /> Pcmut tri or Dlte 79_50 Other NN ell No Z I•-1 7 E_ -3 0 <br /> pppp <br /> (1) OWNER \I B tic P� Development (12) WELL LOG Total depth 290 ft Depth of completed ,sell 2oUit <br /> Address 3240 Ad Art stay from ft to ft Form•ition (Describe by color chlracter size nt matenll) <br /> City S oc on, a. Lip 0 - op soy <br /> 12 c ay <br /> (2) LOC TION OF WELL (See instructions) <br /> J <br /> Count+ ban Oaquj n y 0,net s Nk ell\umber 12 - 25 me sari <br /> NN ell tddress if different from itime 2953 N. Cherrylarid 25 clay y <br /> TuNsnship Stovxton Rtnl -blac c a <br /> .e Secuun - <br /> Dmince from cities roads r-tdroids fences etc 1 mile 14; Of Stoci,,ton 50 80 < meci shad <br /> on State Hiway 88 500 yds N of bb 175 ft a of 80it - 1.12 \\ti,brown clay <br /> Cherryland 112 - \\med sari <br /> - 137 . , clay <br /> (3) TYPE OF Ni ORK 137 ,/ . • sari <br /> X well \en NN ell L� Deepening ❑ brown clay <br /> Reomstniction ❑ ZU5424 <<,Med sari <br /> Che la enpdihunmv ❑ - F=, Slle pea grave <br /> 52 <br /> Honzuntal NN ell ❑ - \ !\tery <br /> Destruction {] (Describe y\,� - \�\ y med sari <br /> cL <br /> destruction m aerials ind <br /> pr,xedures in Item 1Z) <br /> (4) PROPOSED USE ' <br /> Domestic <br /> Irrigltinn <br /> Industrial '- <br /> Test Well . ❑ <br /> State Hiway 88 Stock <br /> Nlumctpal a <br /> '«ELL LOCATION SKETCH Other ❑ <br /> (5) EQUIPMENT (6) GRAVEL PACK Qj - <br /> Rotan [ Reverie ❑ ]es 99 NO C] Size pea <br /> Cthle ❑ Air ❑ Diameter of bare12- <br /> r <br /> Other ❑ Bucket (] Picked Irom 2 - <br /> (7) CASI\G I\STALLED (8) PERFORATIO\S \ <\ - <br /> Steel ❑ P1istic`O Concrete ❑ Type of perforation or srze of screen , <br /> Froin To - Dia G.lge or From --' To Slot`> - <br /> ft ft )n Nall ft ft "s ze, - <br /> 288 -o- 6 1.60 288 248 1/16x5 <br /> - <br /> (9) WELL SE aL J - <br /> Was surflce s initar) seal provided' les No ❑ If )es, to depth 50 ft - <br /> Were strltl sealed i6,unst pollutiorP ]es C❑ \o lntenll ft <br /> Method of sealing Poured cement grout. NN'ork started 5-18-79 ,19- Completed - C] 19 <br /> (10) NATER LEVELS WELL DRILLERS STATEMENT <br /> Depth of first }Nater if knoNst -0 It This uell utas drilled under my jurisdiction and this report is !rile to the hest of rruf I <br /> St%nding le%el Ifter %sell complchon -0- ft kno0edge and belief rC� <br /> tt�Va <br /> (11) WELL TESTS , 5tc\h t I (Ni'eiI Driller) <br /> NNIS well test mlde� ]es E) \o L7 ]f Nes b. N%hom° e Dr1111 Co. <br /> T%pe of test Pump C] Bltler C] Air lift ❑ <br /> Depth to %Nater it stlrt of test ft -%t end of test ft (Person B�J�or corporation) (Typed or printed) <br /> Address B'C•BOX 1`t'-Y <br /> Irge :'Il/min Ifter hours NVlter temperature 9538`T <br /> }� City Va1le� Home Zip <br /> at wtl,sis mldc' Yes C \o lJ If Nes bs +,hom" 5� <br /> t <br /> ss electric log mldL' Yes ❑ No � if Nes Ittich copy to this report License ho " Date of this report^ 6""�1=�• <br /> DWR 188 (REV 7 76) IF ADDITIONAL SPACE 15 NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />