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RIGINAL STATE OF CALIFORNIA Do not fill to <br /> THE RESOURCES AGENCY <br /> le with DWR DEPARTMENT OF WATER RESOURCES No. 40479 <br /> f,t a of Intent No WATER WELL DRILLERS REPORT State well No <br /> I) Pcrrrnt No or Dxtr <br /> " W Other Well Nt, <br /> �rNER ,an,c Andrew Rossi (12) WELL LOG Tutul drhlh 175 I1 Depth „f —mpleied µe11175_fl <br /> 17659 S. Airport ri_q y from ft to ft Fnmirtion (Descnbe by rnlor character cure nr matemll <br /> Manteca Calif. �p 0-1 S <br /> Qnd <br /> LO�ATIO�N OF WELL (St.e utstructton,) 1 20 Blue C <br /> ,nt, Jan oaauln _Os,ner, N%ell \unihci 20-2[7] and <br /> 11 iddress if thlltrent fr,+m ih„t 27-27 Via X <br /> ii'llip� TLIq R knit_ R6F —S..,tt o: <br /> 29-46 <br /> u er lrum uLes raids rule nd� Ernce, etc <br /> Clak shale <br />-np-. North of H 0West- 75-83 and gravel <br /> 'Gla--y <br /> -- <br /> 94-116 " \ Shale cla <br /> (3) T]PE OF WORK 3 2 band <br /> Ne„ 1\ell.V Deepening ❑ la <br /> RrconbtrtiLtlun ❑ - axid & gravel <br /> Reuindmonml, ❑ - <br /> H-wizontA %%ell ❑ ��\ - \♦ �_ <br /> 41 <br /> Destruction '❑ (Describe - <br /> destroL ttort m sten uls and <br /> pymedures in Item V—Y <br /> (4) PROPOSED'U'S - <br /> D mr,nc A - - <br /> lndustrml �` `1 ❑ -„ ` <br /> .� <br /> Test R ell �\ ❑ <br /> % Municipal �v - <br /> WELL LOCATION SKETCH � 4 Other ❑ - <br /> IPNIE%T I61 CRANII�Is PACK <br /> tan .� He,erse ❑ �m2gN\1ID Stze ID lF��X <br /> ble ❑ Air ❑ ` � of bare <br /> her ❑ Bucket ❑ �11�.�tz�z;:!"efrrom—135 tcj� lr5 !tCASING INSTALLED � (81PI-RFORA*6INS and Cut C <br /> LI ❑ Plastic &K C \C T,pe of perf r n or vze of screen <br /> From To DIa G r F o \ To <br /> N <br /> ft f '� m Wall f ft - <br /> 1 16ow 15 <br /> 5 17.6, - <br /> t\ <br /> 1) WELL SEAL C�/(�j <br /> is surf-ice slnitan seal pro,idedO les [X' No C] If ,es to dcptl- 50 it <br /> ere strata sealed -i�,amst pollution” les ❑ No ❑ Inten-il ft <br /> thnd of selling Bentonite \\ uk stzrted cJ ComplLted I9 <br /> 10) WATER LEVELS M ELL DRILLERS STATE1\1E1\T <br /> pth of first µiter if knn,sn --- ft Ihrs uctl uas drzi!Ld tattler ms( Aensdicrion and lhts reporl is true In he best ref mir <br /> indmF lexel ifter well tompletto 1 ft 7 nowledge and belief <br /> 1) WELL TESTS SIGNEnis well test ni,deo ] sNn ` nhnnl (lMell Drdlet <br /> pe of test Pump ❑ B1ler ❑ Air lift ❑ N A ME— <br /> Henning S Bros DriJ3.1n C <br /> spth to water at start of test ft At end of lest ft r ( '{rsu�l rm�etuc �izrt�tion�(,Tspcd ur prnttedl <br /> Address 56b f 1e+ M o <br /> gmicge nal/min liter hour, 11 iter temperature Modesto, Calif. 0 <br /> tttntcal annhsts made' ye, ,❑ 'fin� If ,es b, s,honu' Cut` lel <br /> ^lectne Nog made" les ❑ N If ,es -ttt Itch Lop% to this report License No Date of this report <br /> 6)11 1REV -1 7 61 IF ADDITIONAL SPACE 15 NEEDED USE NEXT CONSECUTIVELY NU MBERI D FORM •3411695°] 76 50w aaeo C?r Ose <br />